Intracortical electroencephalography in acute brain injury

Waziri, Allen; Claassen, Jan; Stuart, R. Morgan; Arif, Hiba; Schmidt, J. Michael; Mayer, Stephan A.; Badjatia, Neeraj; Kull, Lewis L.; Connolly, E. Sander; Emerson, Ronald G.; Hirsch, Lawrence J.

doi:10.1002/ana.21721

Cited by 114 publications

(97 citation statements)

References 25 publications

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“…Depth EEG monitoring may also at times be helpful in clarifying questionable surface EEG findings [36]. Our patient did not undergo multimodality monitoring and MR spectroscopy was technically limited.…”

Section: Strategymentioning

confidence: 96%

How I Treat Patients with EEG Patterns on the Ictal–Interictal Continuum in the Neuro ICU

Claassen

2009

Neurocrit Care

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Refractory status epilepticus (RSE) is associated with a high risk of poor outcome and treated by most neurointensivists with continuous intravenous antiepileptic medications (cIV-AEDs). Continuous EEG monitoring has allowed us to unveil a number of epileptiform patterns of less certain significance. These have been labeled ictal to interictal continuum (IIC), many of which are associated with poor outcome. It is unclear to which extent individual patterns are epiphenomena or lead to additional brain injury. The treatment of these patterns is highly controversial and guidelines how to manage them are non existent. In this review of a challenging case, I will discuss a number of approaches to determine the ictal nature of the IIC in an effort to minimize neuronal injury from epileptiform brain activity on the one hand and from the treatment on the other hand. Ultimately it will be most important to replace the dichotomy of ictal versus non-ictal patterns by differentiating between harmful and non-harmful patterns.

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Section: Strategymentioning

confidence: 96%

How I Treat Patients with EEG Patterns on the Ictal–Interictal Continuum in the Neuro ICU

Claassen

2009

Neurocrit Care

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“…Recordings in critically ill subjects with simultaneous scalp and intracortical electrodes have revealed that some instances of focal RDA seen on scalp EEG correspond to intracranial periodic epileptiform discharges or periodic bursts. 27 However, there were some differences between LRDA and LPDs. Lateralized rhythmic delta activity occurred in shorter runs, typically less than 10 seconds and almost always less than 1 minute, whereas LPDs tend to occur in more prolonged runs, often lasting minutes to hours (eFigure in Supplement).…”

Section: Similarity To Lpdsmentioning

confidence: 99%

Similarity of Lateralized Rhythmic Delta Activity to Periodic Lateralized Epileptiform Discharges in Critically Ill Patients

et al. 2013

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The increasing use of continuous electroencephalography (EEG) monitoring in the intensive care unit has led to recognition of new EEG patterns that are of unclear or unknown significance.OBJECTIVE To describe an EEG pattern, lateralized rhythmic delta activity (LRDA), encountered in critically ill subjects and determine its clinical significance in this setting. DESIGN, SETTING, AND PARTICIPANTSRetrospective review at an academic medical center of EEG recordings, medical records, and imaging studies of critically ill patients with LRDA and comparison with subjects with lateralized periodic discharges (also known as periodic lateralized epileptiform discharges), subjects with focal nonrhythmic slowing, and controls. INTERVENTION Electroencephalography or continuous electroencephalography.MAIN OUTCOMES AND MEASURES Cross-sectional prevalence of lateralized rhythmic delta activity; EEG characteristics; etiology, clinical, and radiological correlates; and risk of early seizures. RESULTSWe identified LRDA in 4.7% of acutely ill subjects undergoing EEG or continuous EEG monitoring. It was often associated with other focal EEG abnormalities, including lateralized periodic discharges in 44% of cases. The most common conditions associated with LRDA were intracranial hemorrhage and subarachnoid hemorrhage. Lateralized rhythmic delta activity was an independent predictor of acute seizures, with 63% of subjects having seizures during their acute illness, a proportion similar to subjects with lateralized periodic discharges (57%) and significantly higher than associated with focal nonrhythmic slowing (20%) or in control subjects (16%). Most patients (80%-90%) in the LRDA and lateralized periodic discharges groups who had seizures while undergoing continuous EEG monitoring had only nonconvulsive seizures, whereas this was the case for only 17% of patients in the other groups. Lateralized rhythmic delta activity and lateralized periodic discharges were both associated with lesions involving the cortex or juxtacortical white matter. CONCLUSIONS AND RELEVANCELateralized rhythmic delta activity in critically ill patients has a similar clinical significance as lateralized periodic discharges. It reflects the presence of a focal lesion and is associated with a high risk of acute seizures, especially nonconvulsive.

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“…A considerable number of patients with acute brain injury has been demonstrated to exhibit pure electroencephalographic discrete or continuous seizure activity [Waziri et al 2009]. Although such EEG activity in traumatic brain injury may be associated with the development of hippocampal atrophy, a causal relationship has not been proven [Vespa et al 2010].…”

Section: Eeg Patternsmentioning

confidence: 99%

Nonconvulsive status epilepticus: a diagnostic and therapeutic challenge in the intensive care setting

Holtkamp

Meierkord

2011

Ther Adv Neurol Disord

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Nonconvulsive status epilepticus (NCSE) comprises a group of syndromes that display a great diversity regarding response to anticonvulsants ranging from virtually self-limiting variants to entirely refractory forms. Therefore, treatment on intensive care units (ICUs) is required only for a selection of cases. The aetiology and clinical form of NCSE are strong predictors for the overall prognosis. Absence status epilepticus is commonly seen in patients with idiopathic generalized epilepsy and is rapidly terminated by low-dose of benzodiazepines. The management of complex partial status epilepticus is straightforward in patients with preexisting epilepsy, but poses major problems if occurring in the context of acute brain lesions. Subtle status epilepticus represents the late stage of undertreated previous overt generalized convulsive status epilepticus and always requires aggressive ICU treatment. Within the intensive care setting, the diagnostic challenge may be seen in the difficulty in delineating nonepileptic conditions such as posthypoxic, metabolic or septic encephalopathies from NCSE. Although all important forms are considered, the focus of this review lies on clinical presentations and electroencephalogram features of comatose patients treated on ICUs and possible diagnostic pitfalls.

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Intracortical electroencephalography in acute brain injury

Cited by 114 publications

References 25 publications

How I Treat Patients with EEG Patterns on the Ictal–Interictal Continuum in the Neuro ICU

How I Treat Patients with EEG Patterns on the Ictal–Interictal Continuum in the Neuro ICU

Similarity of Lateralized Rhythmic Delta Activity to Periodic Lateralized Epileptiform Discharges in Critically Ill Patients

Nonconvulsive status epilepticus: a diagnostic and therapeutic challenge in the intensive care setting

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