Periodic lateralized epileptiform discharges with transitional rhythmic discharges: association with seizures

Reiher, Jean; Rivest, J.; Maison, F.Grand; Leduc, C. P.

doi:10.1016/0013-4694(91)90013-t

Cited by 133 publications

(81 citation statements)

References 4 publications

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“…Although both were associated with a similar risk of seizures, we believe that B(I)RDs represent a different phenomenon than LPDs for the following reasons: (1) LPDs are by definition periodic, whereas B(I)RDs were sporadic; (2) LPDs occur in prolonged runs, usually lasting days, whereas by definition B(I)RDs are very brief; (3) LPDs persisted after seizures when the latter were controlled, whereas B(I)RDs ceased in all patients in whom seizures were successfully treated; (4) LPDs and B(I)RDs can occur in the same patient or they can be seen independently; (5) in 11 patients with both patterns, B(I)RDs occurred independently of LPDs in 8 cases; (6) in patients with LPDs and B(I)RDs, B(I)RDs did not occur consistently with most LPDs as opposed to the low-amplitude, very brief rhythmic activity that is associated with most discharges (termed PLEDs-plus in the past 20 and now referred to as +F in the American Clinical Neurophysiology Society's Standardized Critical Care EEG Terminology 1 ); and (7) B(I)RDs and LPDs were both independently associated with a greater risk of seizure. So-called benign EEG variants, such as wicket spikes, 14-and 6-Hz positive bursts, and rhythmic temporal theta bursts of drowsiness, can occur as short runs of sharp and rhythmic theta activity and could be mistaken for B(I)RDs, especially in the temporal and temporoparietal regions.…”

Section: Discussionmentioning

confidence: 92%

Brief Potentially Ictal Rhythmic Discharges in Critically Ill Adults

et al. 2014

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ontinuous electroencephalography (CEEG) monitoring is used increasingly to assess brain function in critically ill patients. Substantial efforts have been made to standardize critical care EEG terminology and to associate EEG patterns with clinical course and outcome. [1][2][3][4][5] One of the main indications for CEEG is to detect electrographic seizures. Most electroencephalographers use a definition of seizures that includes a minimal duration of 10 seconds, 2-7 which reflects the typical duration of partial seizures in patients with chronic epilepsy. [8][9][10] Rhythmic ictal-appearing patterns lasting less than 10 seconds have been described in neonates under different acronyms: brief rhythmic discharges (BRDs), brief electroencephalography rhythmic discharges (BERDs), and brief ictal rhythmic discharges (BIRDs). [11][12][13] In neonates, these patterns encompass discharges of any frequency, including less than 4 Hz, because they are common in this age group. Rhythmic delta activity and periodic discharges with a frequency of less than 4 Hz are common in critically ill patients but are usually not considered to be ictal. 3,5 Ictal discharges in children and adults often have a higher frequency than those in neonates. The occurrence of brief rhythmic discharges with a frequency higher than 4 Hz has never been studied in these older age groups.In this study, we sought to investigate the prevalence, significance, and prognostic implication of these discharges. In addition, we propose the acronym B(I)RDs (brief potentially ictal rhythmic discharges; the parentheses in the acronym indicate that their ictal nature is equivocal) in a group of critically ill patients. IMPORTANCE Brief potentially ictal rhythmic discharges, termed B(I)RDs, have been described mainly in neonates, and their significance in adults remains unclear.OBJECTIVE To describe the incidence of B(I)RDs in critically ill patients and investigate their association with seizures and outcome. DESIGN, SETTING, AND PARTICIPANTSWe reviewed the records of prospectively identified patients with B(I)RDs and patients serving as controls matched for age (±5 years) and primary diagnosis. MAIN OUTCOMES AND MEASURESThe prevalence of seizures during continuous electroencephalography and functional outcome, as measured by the Glasgow Outcome Scale, were determined. RESULTSWe identified B(I)RDs in 20 patients (2%). The pattern most often consisted of very brief (1-3 seconds) runs of sharply contoured theta activity without obvious evolution. All patients with B(I)RDs had cerebral injury, and in cases with a single focal lesion (11 [55%]), B(I)RDs were localized in the same region in all but 2 cases (18%). Patients with B(I)RDs were more likely to have seizures during continuous electroencephalography than were patients without B(I)RDs (15 of 20 [75%] vs 10 of 40 [25%]; P < .001), and 9 patients with B(I)RDs (60%) had only subclinical seizures. Brief potentially ictal rhythmic discharges were identified before seizures in all but 1 case (93%) and ceased in all 12 ...

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Section: Discussionmentioning

confidence: 92%

Brief Potentially Ictal Rhythmic Discharges in Critically Ill Adults

et al. 2014

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“…However, they are not routinely suppressed with continuous infusions given that their significance may vary from patient to patient. Certain patterns of PLEDs with intervening rhythmic activity, typically of low amplitude, may be associated with greater risk of seizure [60,61].…”

Section: Periodic Dischargesmentioning

confidence: 99%

The Utility of EEG, SSEP, and Other Neurophysiologic Tools to Guide Neurocritical Care

Rosenthal

2012

Neurotherapeutics

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Neuromonitoring is an emerging field that aims to characterize real-time neurophysiology to tailor therapy for acute injuries of the central nervous system. While cardiac telemetry has been used for decades among patients requiring critical care of all kinds, neurophysiology and neurotelemetry has only recently emerged as a routine screening tool in comatose patients. The increasing utilization of electroencephalography in comatose patients is primarily due to the recognition of the common occurrence of nonconvulsive seizures among comatose patients, the development of quantitative measures to detect regional ischemia, and the appreciation of electroencephalography phenotypes that indicate prognosis after cardiac arrest. Other neuromonitoring tools, such as somatosensory evoked potentials have a complementary role, surveying the integrity of the neuroaxis as an indicator of prognosis or illness progression in both acute brain and spinal injuries.

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“…Thus, they could be considered a nonspecific result of acute partial and transient functional denervation in a localized area of the cortex 15 . Reiher et al 17 proposed a subclassification of PLEDs in two major groups: PLEDs-proper, in which the periodicity of the discharges is relatively stable, the discharges are simply configured and uniform, and there are no associated rhythmic discharges; and PLEDs-plus, in which the periodicity of the discharges is variable and there is associated low amplitude rhythmic activity with the discharges. It seems that PLEDsplus pattern is more associated with seizures, but few studies suggested significant risk stratification for it 2,15,17 .…”

Section: Periodic Lateralized Epileptiform Dischargespledsmentioning

confidence: 99%

“…Reiher et al 17 proposed a subclassification of PLEDs in two major groups: PLEDs-proper, in which the periodicity of the discharges is relatively stable, the discharges are simply configured and uniform, and there are no associated rhythmic discharges; and PLEDs-plus, in which the periodicity of the discharges is variable and there is associated low amplitude rhythmic activity with the discharges. It seems that PLEDsplus pattern is more associated with seizures, but few studies suggested significant risk stratification for it 2,15,17 . Chong et al 2 reported their experience with 24-hour continuous EEG recordings (coEEG) and observed that PLEDs-proper rarely occurs in isolation, with the EEG typically fluctuating between PLEDs-proper and PLEDs-plus, with high seizures risk in these patients.…”

Section: Periodic Lateralized Epileptiform Dischargespledsmentioning

confidence: 99%

Periodic EEG patterns: importance of their recognition and clinical significance

Andraus

Alves-Leon

2012

Arq. Neuro-Psiquiatr.

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Periodic electroencephalographic (EEG) patterns consist of discharges usually epileptiform in appearance, which occur at regular intervals, in critical patients. They are commonly classified as periodic lateralized epileptiform discharges (PLEDs), bilateral independent PLEDs or BIPLEDs, generalized epileptiform discharges (GPEDs) and triphasic waves. Stimulus-induced rhythmic, periodic or ictal discharges (SIRPIDs) are peculiar EEG patterns, which may be present as periodic discharges. The aim of this study is to make a review of the periodic EEG patterns, emphasizing the importance of their recognition and clinical significance. The clinical significance of the periodic EEG patterns is uncertain, it is related to a variety of etiologies, and many authors suggest that these patterns are unequivocally epileptogenic in some cases. Their recognition and classification are important to establish an accurate correlation between clinical, neurological, laboratorial and neuroimaging data with the EEG results.

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Periodic lateralized epileptiform discharges with transitional rhythmic discharges: association with seizures

Cited by 133 publications

References 4 publications

Brief Potentially Ictal Rhythmic Discharges in Critically Ill Adults

Brief Potentially Ictal Rhythmic Discharges in Critically Ill Adults

The Utility of EEG, SSEP, and Other Neurophysiologic Tools to Guide Neurocritical Care

Periodic EEG patterns: importance of their recognition and clinical significance

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