American journal of electroneurodiagnostic technology
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EEG recording in the intensive care setting presents a number of technical challenges. It is essential to differentiate artifact from pathophysiologic EEG changes that would suggest encephalopathy, epileptiform activity, or seizures. ⋯ Epileptiform patterns, including periodic lateralized epileptiform discharges (PLEDs), bilateral independent periodic lateralized epileptiform discharges (BIPLEDs), and generalized periodic epileptiform discharges (GPEDs), present particular challenges as there is a gray-zone between interictal patterns and the evolving (usually faster) patterns of nonconvulsive seizures. Accurate use of EEG in the intensive care unit requires optimal EEG technical expertise in performing the study, and appropriate interpretation by a trained electrophysiologist.
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Reflex seizures are evoked by a specific afferent stimulus or by activity of the patient and are divided into those characterized by generalized seizures and those principally manifested by focal seizures. Reflex epilepsies are syndromes in which all epileptic seizures are precipitated by sensory stimuli. Three categories of reflex seizures encountered clinically include pure reflex epilepsies, reflex seizures that occur in generalized or focal epilepsy syndromes that are also associated with spontaneous seizures, and isolated reflex seizures occurring in situations that do not necessarily require a diagnosis of epilepsy. ⋯ The triggers include reading, writing, other language functions, startle, somatosensory stimulation, proprioception, auditory stimuli, immersion in hot water, eating, and vestibular stimulation. The classification and characteristics of reflex seizures and epilepsies are described in this review. Findings on EEG and advanced neuroimaging in the reflex seizures and epilepsies, treatment and preventive options, and animal models and mechanisms are also discussed.
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Am J Electroneurodiagnostic Technol · Mar 2006
Ellen R. Grass Lecture: Rapid EEG analysis for intensive care decisions in status epilepticus.
Nonconvulsive status epilepticus in intensive care units (ICUs) is common and increases the risk of death. Nonconvulsive status epilepticus treatment delays are associated with poor patient outcomes. Continuous EEG or EEG-video monitoring is used in ICU settings to diagnose subtle seizures and nonconvulsive status epilepticus among at-risk populations including patients with closed head injuries and altered consciousness, stroke, subarachnoid hemorrhage, neonates at-risk for sepsis or hypoxic-ischemic encephalopathy, and children who have undergone surgery for congenital heart disease. ⋯ At most hospitals the numbers of at-risk patients in intensive care units far exceeds the capacity of the available EEG equipment and personnel to perform and interpret EEGs. Seizure-detection software, compressed EEG spectral arrays, and near real-time remote EEG interpretation have brought us closer to the goal of real-time analysis of EEG for intensive care decisions, but even at major tertiary referral centers the vast majority of at-risk ICU patients do not undergo EEG monitoring. Additional technological advances, innovative use of EEG technologists and ICU personnel, and clinical trials of new EEG monitoring technology and associated clinical outcomes are needed to achieve the goal of optimal use of EEG data for intensive care decisions.
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Am J Electroneurodiagnostic Technol · Jun 2005
Regional attenuation without delta (RAWOD): a distinctive EEG pattern that can aid in the diagnosis and management of severe acute ischemic stroke.
Acute thrombolysis with recombinant tissue plasminogen activator (tPA) is the only treatment of proven effectiveness in acute ischemic stroke (AIS). Cerebral edema (CE) is the most feared and fatal complication of AIS. For both of these conditions, patient selection for treatment and timing of intervention are crucial but controversial issues. ⋯ This article suggests that the use of Emergency EEG (EmEEG) in AIS can reveal a distinctive EEG pattern that adds value to the selection of patients for thrombolytic and cerebral edema treatment. This pattern, called RAWOD (Regional Attenuation WithOut Delta) can identify patients with massive AIS earlier than CT or MRI. Patients with RAWOD are unlikely to benefit from thrombolysis but may be candidates for early surveillance and intervention for cerebral edema.