The neuro-ICU patient and electroencephalography paroxysms: If and when to treat

Current Opinion in Critical Care

Volumn 16, Issue 2, 2010, Pages 105-109

  Rossetti, Andrea O ^a   Oddo, Mauro ^b  

^a Department of Neurology ^*  (Switzerland)

^b LAUSANNE UNIVERSITY HOSPITAL   (Switzerland)

Author keywords

Continuous electroencephalography monitoring; Electrographic seizures; Hypoxicischemic encephalopathy; Intracerebral hemorrhage; Status epilepticus; Subarachnoid hemorrhage; Traumatic brain injury

Indexed keywords

ANESTHETIC AGENT; ANTICONVULSIVE AGENT; BENZODIAZEPINE; CLONAZEPAM; DIAZEPAM; ETIRACETAM; LORAZEPAM; MIDAZOLAM; PHENOBARBITAL; PHENYTOIN; PROPOFOL; THIOPENTAL; VALPROIC ACID;

ANESTHESIA INDUCTION; ANESTHESIA LEVEL; BRAIN DAMAGE; BRAIN ISCHEMIA; CLINICAL DECISION MAKING; COMORBIDITY; CRITICALLY ILL PATIENT; DEEP SEDATION; DISEASE SEVERITY; DOSE RESPONSE; DRUG CONTRAINDICATION; DRUG EFFICACY; DRUG MEGADOSE; DRUG TOLERABILITY; ELECTROENCEPHALOGRAPHY; EPILEPTIC STATE; HUMAN; ILEUS; INDUCED HYPOTHERMIA; INTENSIVE CARE; INTENSIVE CARE UNIT; METABOLIC DISORDER; MYOPATHY; NERVE INJURY; NEUROMONITORING; PROGNOSIS; PROPOFOL INFUSION SYNDROME; REVIEW; SEIZURE; SUBARACHNOID HEMORRHAGE; THROMBOEMBOLISM; TRAUMATIC BRAIN INJURY; TREATMENT INDICATION; TREATMENT PLANNING; UNSPECIFIED SIDE EFFECT;

BRAIN DISEASES; BRAIN INJURIES; ELECTROENCEPHALOGRAPHY; HUMANS; HYPOXIA-ISCHEMIA, BRAIN; INTENSIVE CARE UNITS; INTRACRANIAL HEMORRHAGES; PROGNOSIS; SEIZURES; STATUS EPILEPTICUS; SUBARACHNOID HEMORRHAGE;

EID: 77952257252     PISSN: 10705295     EISSN: 15317072     Source Type: Journal    
DOI: 10.1097/MCC.0b013e3283374b5b     Document Type: Review

References (47)

1. Friedman D, Claassen J, Hirsch LJ. Continuous electroencephalogram mon-itoring in the intensive care unit. Anesth Analg 2009;109:506-523. An elegant and comprehensive overview of usefulness and limitations of cEEG I the ICU.
2. Chen JW, Naylor DE, Wasterlain CG. Advances in the pathophysiology of status epilepticus. Acta Neurol Scand Suppl 2007;186:7-15.
3. Kull LL, Emerson RG. Continuous EEG monitoring in the intensive care unit: technical and staffing considerations. J Clin Neurophysiol 2005;22:107-118. (Pubitemid 40490402)
4. Chong DJ, Hirsch LJ. Which EEG patterns warrant treatment in the critically ill? Reviewing the evidence for treatment of periodic epileptiform discharges and related patterns. J Clin Neurophysiol 2005;22:79-91.
5. Hirsch LJ, Claassen J, Mayer SA, Emerson RG. Stimulus-induced rhythmic, periodic, or ictal discharges (SIRPIDs) : a common EEG phenomenon in the critically ill. Epilepsia 2004;45:109-123. (Pubitemid 38174117)
6. Temkin NR, Dikmen SS, Wilensky AJ, et al. A randomized, double-blind study of phenytoin for the prevention of posttraumatic seizures. N Engl J Med 1990;323:497-502. (Pubitemid 20260049)
7. Bratton SL, Chestnut RM, Ghajar J, et al. Guidelines for the management of severe traumatic brain injury. XIII. Antiseizure prophylaxis. J Neurotrauma 2007; 24 (Suppl 1) : S83-S86.
8. Hesdorffer DC, Benn EK, Cascino GD, Hauser WA. Is a first acute symptomatic seizure epilepsy? Mortality and risk for recurrent seizure. Epilepsia 2009;50:1102-1108.
9. Chang BS, Lowenstein DH. Practice parameter: antiepileptic drug prophylaxis in severe traumatic brain injury - report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2003;60:10-16.
10. Szaflarski JP, Sangha KS, Lindsell CJ, Shutter LA. Prospective, randomized, single-blinded comparative trial of intravenous levetiracetam versus phenytoin for seizure prophylaxis. Neurocrit Care [Epub ahead of print]. DOI:10.1007/s12028-009-9304-y. This unblinded randomized trial shows, on 52 patients with severe TBI, that seizure prophylaxis with levetiracetam seems equally effective but better tolerated as compared with phenytoin.
11. Vespa PM, Miller C, McArthur D, et al. Nonconvulsive electrographic seizures after traumatic brain injury result in a delayed, prolonged increase in intracranial pressure and metabolic crisis. Crit Care Med 2007;35:2830-2836. (Pubitemid 350175782)
12. Vespa PM, Nuwer MR, Nenov V, et al. Increased incidence and impact of nonconvulsive and convulsive seizures after traumatic brain injury as detected by continuous electroencephalographic monitoring. J Neurosurg 1999;91:750-760. (Pubitemid 30053146)
13. Ronne-Engstrom E, Winkler T. Continuous EEG monitoring in patients with traumatic brain injury reveals a high incidence of epileptiform activity. Acta Neurol Scand 2006;114:47-53. (Pubitemid 43873524)
14. Olivecrona M, Zetterlund B, Rodling-Wahlstrom M, et al. Absence of electro-encephalographic seizure activity in patients treated for head injury with an intracranial pressure-targeted therapy. J Neurosurg 2009;110:300-305. The authors show that an ICP guide sedation therapy on 47 patients with severe TBI prevented seizures on cEEG.
15. Amantini A, Fossi S, Grippo A, et al. Continuous EEG-SEP monitoring in severe brain injury. Neurophysiol Clin 2009;39:85-93. In 68 individuals suffering from ICH and TBI, the authors found that variation of SSEP, recorded together with EEG, may precede variations in ICP and clinical deterioration.
16. Claassen J, Peery S, Kreiter KT, et al. Predictors and clinical impact of epilepsy after subarachnoid hemorrhage. Neurology 2003;60:208-214. (Pubitemid 36152010)
17. Lin YJ, Chang WN, Chang HW, et al. Risk factors and outcome of seizures after spontaneous aneurysmal subarachnoid hemorrhage. Eur J Neurol 2008;15:451-457. (Pubitemid 351499187)
18. Rosengart AJ, Huo JD, Tolentino J, et al. Outcome in patients with subarachnoid hemorrhage treated with antiepileptic drugs. J Neurosurg 2007;107:253-260. (Pubitemid 47219366)
19. Shah D, Husain AM. Utility of levetiracetam in patients with subarachnoid hemorrhage. Seizure 2009;18:676-679.
20. Claassen J, Mayer SA, Kowalski RG, et al. Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology 2004;62:1743-1748. (Pubitemid 38661728)
21. Claassen J, Hirsch LJ, Frontera JA, et al. Prognostic significance of continuous EEG monitoring in patients with poor-grade subarachnoid hemorrhage. Neurocrit Care 2006;4:103-112. (Pubitemid 43793339)
22. Dennis LJ, Claassen J, Hirsch LJ, et al. Nonconvulsive status epilepticus after subarachnoid hemorrhage. Neurosurgery 2002;51:1136-1143; discussion 1144. (Pubitemid 36322699)
23. Naidech AM, Garg RK, Liebling S, et al. Anticonvulsant use and outcomes after intracerebral hemorrhage. Stroke 2009;40:3810-3815.
24. Messe SR, Sansing LH, Cucchiara BL, et al. Prophylactic antiepileptic drug use is associated with poor outcome following ICH. Neurocrit Care 2009;11:38-44. AED use (mostly phenytoin) after ICH was independently associated with worse outcome in patients having been enrolled in the placebo arm of atrial investigating a potential neuroprotectant.
25. Vespa PM, O'Phelan K, Shah M, et al. Acute seizures after intracerebral hemorrhage: a factor in progressive midline shift and outcome. Neurology 2003;60:1441-1446. (Pubitemid 36554803)
26. Yang TM, Lin WC, Chang WN, et al. Predictors and outcome of seizures after spontaneous intracerebral hemorrhage. Clinical article. J Neurosurg 2009;111:87-93. Seizures developed in 20 of the 243 patients with spontaneous ICH. This retrospective analysis identified hemorrhage volume as the most important seizure predictor.
27. PasseroS, Rocchi R, Rossi S, et al. Seizures after spontaneous supratentorial intracerebral hemorrhage. Epilepsia 2002;43:1175-1180. (Pubitemid 35176125)
28. Claassen J, Jette N, Chum F, et al. Electrographic seizures and periodic discharges after intracerebral hemorrhage. Neurology 2007;69:1356-1365. (Pubitemid 47482450)
29. American Heart Association Guidelines 2005 for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2005; 112 (Suppl 24) : IV1-203.
30. Young GB. Clinical practice. Neurologic prognosis after cardiac arrest. N Engl J Med 2009;361:605-611.
31. Rossetti AO, Logroscino G, Liaudet L, et al. Status epilepticus: an independent outcome predictor after cerebral anoxia. Neurology 2007;69:255-260. (Pubitemid 47205687)
32. Rossetti AO, Oddo M, Liaudet L, Kaplan PW. Predictors of awakening from postanoxic status epilepticus after therapeutic hypothermia. Neurology 2009;72:744-749. This observational analysis identified six patients awakening after postanoxic status epilepticus; all of them had preserved SSEP, brainstem reflexes and reactivity of their EEG background activity.
33. Zandbergen EG, Hijdra A, Koelman JH, et al. Prediction of poor outcome within the first 3 days of postanoxic coma. Neurology 2006;66:62-68. (Pubitemid 43739593)
34. Abend NS, Topjian A, Ichord R, et al. Electroencephalographic monitoring during hypothermia after pediatric cardiac arrest. Neurology 2009;72:1931-1940. Of 19 children undergoing therapeutic hypothermia after cardiac arrest, nine developed seizures (and six of them status epilepticus) that were detected using cEEG during hypothermia and rewarming.
35. Legriel S, Bruneel F, Sediri H, et al. Early EEG monitoring for detecting postanoxic status epilepticus during therapeutic hypothermia: a pilot study. Neurocrit Care, [Epub ahead of print]. DOI:10.1007/s12028-009-9246-4. The authors applied cEEG monitoring in 51 adults treated with hypothermia after cardiac arrest; 40% showed a burst-suppression pattern, and 10% electrographic status epilepticus.
36. Stecker MM, Cheung AT, Pochettino A, et al. Deep hypothermic circulatory arrest: I. Effects of cooling on electroencephalogram and evoked potentials. Ann Thorac Surg 2001;71:14-21. (Pubitemid 32102627)
37. Wijdicks EF, Parisi JE, Sharbrough FW. Prognostic value of myoclonus status in comatose survivors of cardiac arrest. Ann Neurol 1994;35:239-243. (Pubitemid 24050163)
38. Labowitz DL, Hauser WA, Sacco RL. Prevalence and predictors of early seizure and status epilepticus after first stroke. Neurology 2001;57:200-206.
39. Drislane FW, Lopez MR, Blum AS, Schomer DL. Detection and treatment of refractory status epilepticus in the intensive care unit. J Clin Neurophysiol 2008;25:181-186. This retrospective study on 119 patients with status epilepticus highlights that delayed identification and treatment does not seem to be independently related to worse outcome, and that the main prognostic predictor is the cause.
40. Meierkord H, Boon P, Engelsen B, et al. EFNS guideline on the management of status epilepticus. Eur J Neurol 2006;13:445-450. (Pubitemid 43823356)
41. Jordan KG, Hirsch LJ. In nonconvulsive status epilepticus (NCSE), treat to burst-suppression: pro and con. Epilepsia 2006; 47 (Suppl 1) : 41-45.
42. Kaplan PW. No, some types of nonconvulsive status epilepticus cause little permanent neurologic sequelae (or: 'the cure may be worse than the disease'). Neurophysiol Clin 2000;30:377-382.
43. Roberts RJ, Barletta JF, Fong J, et al. Incidence of propofol-related infusion syndrome in critically ill adults: a prospective, multicenter study. Crit Care 2009; 13: R169. In this multicenter study on more of 1000 patients receiving propofol in the ICU, propofol infusion syndrome (PRIS) developed in about 1%.
44. Krishnamurthy KB, Drislane FW. Depth of EEG suppression and outcome in barbiturate anesthetic treatment for refractory status epilepticus. Epilepsia 1999;40:759-762.
45. Rossetti AO, Logroscino G, Bromfield EB. Refractory status epilepticus: effect of treatment aggressiveness on prognosis. Arch Neurol 2005;62:1698-1702. (Pubitemid 41626665)
46. Rossetti AO, Logroscino G, Milligan TA, et al. Status Epilepticus Severity Score (STESS) : a tool to orient early treatment strategy. J Neurol 2008;255:1561-1566. The status epilepticus severity score, calculated on admission and consisting of age, seizure type, level of consciousness, and history of previous seizures, shows a solid negative predictive value for mortality (0.97), meaning that patients with a favorable score are very unlikely to decease. Those might thus be managed, at least at the beginning, without coma induction.
47. Novy J, Logroscino G, Rossetti AO. Refractory status epilepticus: a prospective observational study. Epilepsia 2009 [Epub ahead of print]. doi:10.1111/j.1528-1167.2009.02323.x. This prospective study on refractory status epilepticus confirms that this entity has a serious outcome, but shows that several episodes may be successfully treated without coma induction.