Semiology of subtle motor phenomena in critically ill patients

Florea, Bogdan I.; Beniczky, Simona Alexandra; Demeny, Helga; Beniczky, Sándor

doi:10.1016/j.seizure.2017.03.018

Cited by 16 publications

(4 citation statements)

References 12 publications

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“…Importantly, the vast majority (roughly 90%) of these ictal features occur without any clinical counterpart, hence the terms of “non-convulsive” or “subclinical” seizures or SE [ 23 , 24 ]. To the contrary, about three-quarters of patients showing abnormal movements in the ICU do not have seizure or SE, but other conditions, such as motor stereotyped movements, shivering (relatively frequently observed when general anesthetics are weaned off), subcortical myoclonus, or corticospinal clonus [ 25 , 26 ].…”

Section: Resultsmentioning

confidence: 99%

Continuous versus Routine Electroencephalography in the Intensive Care Unit: A Review of Current Evidence

Fenter,

Rossetti,

Beuchat

2023

Eur Neurol

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Background Electroencephalography has long been used to detect seizures in patients with disorders of consciousness. In recent years, there has been a drastically increased adoption of continuous EEG (cEEG) in the ICUs. Summary Despite the development of increasingly performant imaging techniques and several validated biomarkers, EEG remains central to clinicians in the intensive care unit, and is experiencing expanding indications. Not only does EEG allow seizure or status epilepticus detection, which in the ICU often present without clinical movements, but it is also central for the prognostic evaluation of comatose patients, especially after cardiac arrest, and for detecting delayed ischemia after subarachnoid hemorrhage. Around two decades ago, improvements of technical aspects of recording and storing EEG tracings have led into the era of continuous EEG (cEEG) and automated quantitative analysis (qEEG). Given resources necessary to record and interpret cEEG, this is still not available in every center and widespread recommendations to use continuous instead of routine EEG (typically lasting 20 minutes) are still a matter of debate. In light of recent literature and personal experience, this review offers a rationale to address this question. Key message As compared to repeated rEEG, cEEG in comatose patients does not seem to improve clinical prognosis to a relevant extent, despite allowing a more performant detection ictal events and consequent therapeutic modifications. The choice between cEEG and rEEG must therefore always be patient tailored.

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Section: Resultsmentioning

confidence: 99%

Continuous versus Routine Electroencephalography in the Intensive Care Unit: A Review of Current Evidence

Fenter,

Rossetti,

Beuchat

2023

Eur Neurol

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“…The majority of these events are nonconvulsive, hence only detectable through EEG [38]. Conversely, three-fourth of patients having some sort of abnormal movements in the ICU do not actually seize [39]. Since most of ICU ictal events are not clinically visible, and the majority of movements are not ictal, the importance of systematically coupling video recordings to the EEG appears obvious.…”

Section: Electroencephalogram In Critically Ill Patientsmentioning

confidence: 99%

Recent advances in clinical electroencephalography

Frauscher,

Rossetti,

Beniczky

2024

Current Opinion in Neurology

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Purpose of review Clinical electroencephalography (EEG) is a conservative medical field. This explains likely the significant gap between clinical practice and new research developments. This narrative review discusses possible causes of this discrepancy and how to circumvent them. More specifically, we summarize recent advances in three applications of clinical EEG: source imaging (ESI), high-frequency oscillations (HFOs) and EEG in critically ill patients. Recent findings Recently published studies on ESI provide further evidence for the accuracy and clinical utility of this method in the multimodal presurgical evaluation of patients with drug-resistant focal epilepsy, and opened new possibilities for further improvement of the accuracy. HFOs have received much attention as a novel biomarker in epilepsy. However, recent studies questioned their clinical utility at the level of individual patients. We discuss the impediments, show up possible solutions and highlight the perspectives of future research in this field. EEG in the ICU has been one of the major driving forces in the development of clinical EEG. We review the achievements and the limitations in this field. Summary This review will promote clinical implementation of recent advances in EEG, in the fields of ESI, HFOs and EEG in the intensive care.

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“…Only 25% ultimately had seizures detected on EEG, highlighting the caution required when assessing paroxysmal motor events 7. The most common features included myoclonus, tonic activity, apparent automatisms and eye deviation.…”

Section: Focal Motor Status Epilepticusmentioning

confidence: 99%

Non-convulsive status epilepticus: mimics and chameleons

2018

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Non-convulsive status epilepticus (NCSE) is an enigmatic condition with protean manifestations. It often goes unrecognised, leading to delays in its diagnosis and treatment. The principal reason for such delay is the failure to consider and request an electroencephalogram (EEG), although occasional presentations have no scalp or surface electroencephalographic correlate. In certain settings with limited EEG availability, particularly out-of-hours, clinicians should consider treating without an EEG. Patients need a careful risk-benefit analysis to assess the risks of neuronal damage and harm versus the risks of adverse effects from various intensities of therapeutic intervention. Specialists in EEG, intensive care or epilepsy are invaluable in the management of patients with possible NCSE.

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Semiology of subtle motor phenomena in critically ill patients

Abstract: subtle motor phenomena in critically ill patients can raise the suspicion of NCSE. Nevertheless, EEG is needed to confirm the diagnosis, since none of the semiological features are specific.

Cited by 16 publications

References 12 publications

Continuous versus Routine Electroencephalography in the Intensive Care Unit: A Review of Current Evidence

Continuous versus Routine Electroencephalography in the Intensive Care Unit: A Review of Current Evidence

Recent advances in clinical electroencephalography

Non-convulsive status epilepticus: mimics and chameleons

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