Journal ArticleDOI
Highly Epileptiform Bursts Are Associated With Seizure Recurrence.
TLDR
Whether or not HEBs are indeed predictive of recurrent seizure or may be used to direct the therapy for status epilepticus, specifically the weaning of anesthetic medications, requires further prospective study in a larger cohort of patients.Abstract:
Purpose Pharmacologic sedation is often used to induce burst suppression in cases of refractory status epilepticus, but there is little evidence to guide the weaning of sedation. Similarly, the morphologic feature of bursts is of unknown clinical relevance. Recently, the standardized American Clinical Neurophysiology Society terminology of critical care EEG introduced the term highly epileptiform bursts (HEBs). Knowing the association of HEBs with seizure may direct the therapy for refractory status epilepticus. Methods Consecutive adult patients classified as having burst suppression were identified in our EEG database. Those of an anoxic etiology were excluded. Available EEG records were reviewed, both visually and quantitatively, for the presence of burst suppression. Using the American Clinical Neurophysiology Society terminology, burst suppression was dichotomized into HEBs or nonepileptiform bursts. Periods of transition out of burst suppression were identified, and whether burst suppression was followed by seizure or a continuous slow EEG within 24 hours was determined. Results Twenty-four patients were identified with a burst suppression pattern followed by either seizure or a continuous slow EEG within 24 hours, with some patients having multiple (maximal 5) transitions out of burst suppression, for a total of 33 examples of burst suppression. HEBs were associated with subsequent seizure (P = 0.0001), independent of medication exposure. Conclusions Whether or not HEBs are indeed predictive of recurrent seizure or may be used to direct the therapy for status epilepticus, specifically the weaning of anesthetic medications, requires further prospective study in a larger cohort of patients.read more
Citations
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Journal ArticleDOI
American Clinical Neurophysiology Society's Standardized Critical Care EEG Terminology: 2021 Version.
Lawrence J. Hirsch,Michael W.K. Fong,Markus Leitinger,Suzette M. LaRoche,Sándor Beniczky,Nicholas S. Abend,Jong Woo Lee,Courtney J. Wusthoff,Cecil D. Hahn,M. Brandon Westover,Elizabeth E. Gerard,Susan T. Herman,Hiba A. Haider,Gamaleldin Osman,Andres Rodriguez-Ruiz,Carolina B. Maciel,Emily J. Gilmore,Andres Fernandez,Eric Rosenthal,Jan Claassen,Aatif M. Husain,Ji Yeoun Yoo,Elson L. So,Peter W. Kaplan,Marc R. Nuwer,Michel J.A.M. van Putten,Raoul Sutter,Frank W. Drislane,Eugen Trinka,Nicolas Gaspard +29 more
TL;DR: In the early 2000s, a subcommittee of the American Clinical Neurophysiology Society (ACNS) set out to standardize terminology of periodic and rhythmic EEG patterns in the critically ill to aid in future research involving such patterns as mentioned in this paper.
Anesthetic drugs in status epilepticus: Risk or rescue?
TL;DR: Commenting on “Teaching NeuroImages: ‘Subarachnoid hemorrhage’ from decreased contrast elimination after therapeutic hypothermia,” Rebecca Hurst shares her own experience with pseudo–subarachnis hemorrhage.
Journal ArticleDOI
Updates in Refractory Status Epilepticus.
TL;DR: New-onset refractory status epilepticus (NORSE) is a recently coined term for refractors where no apparent cause is found after initial testing, and a large proportion of cases are eventually found to have an autoimmune etiology needing immunomodulatory treatment.
Journal ArticleDOI
Duration of therapeutic coma and outcome of refractory status epilepticus.
Wolfgang Muhlhofer,Stephen Layfield,Daniel H. Lowenstein,Chee Paul Lin,Robert D. Johnson,Shalini Saini,Jerzy P. Szaflarski +6 more
TL;DR: An optimal window for TC is defined that provides sustained seizure control and minimizes complications in refractory status epilepticus and seizure recurrence, morbidity, and mortality in RSE.
Journal ArticleDOI
EEG Characteristics of Successful Burst Suppression for Refractory Status Epilepticus
TL;DR: The length of interburst intervals and burst suppression did not predict successful termination of RSE in this small cohort, which may suggest that EEG characteristics, rather a strict interburst interval goal, could guide IVAT for RSE.
References
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Journal ArticleDOI
Guidelines for the Evaluation and Management of Status Epilepticus
Gretchen M. Brophy,Rodney Bell,Jan Claassen,Brian K. Alldredge,Thomas P. Bleck,Tracy A. Glauser,Suzette M. LaRoche,James J. Riviello,Lori Shutter,Michael R. Sperling,David M. Treiman,Paul M. Vespa +11 more
TL;DR: Recommendations were developed based on the literature using standardized assessment methods from the American Heart Association and Grading of Recommendations Assessment, Development, and Evaluation systems, as well as expert opinion when sufficient data were lacking.
Journal ArticleDOI
American Clinical Neurophysiology Society's Standardized Critical Care EEG Terminology: 2012 version.
Lawrence J. Hirsch,Suzette M. LaRoche,Nicholas Gaspard,Elizabeth E. Gerard,Alexandra Svoronos,Susan T. Herman,R. Mani,Hiba Arif,Nathalie Jette,Y. Minazad,J. F. Kerrigan,Paul M. Vespa,Stephen Hantus,Jan Claassen,G. B. Young,Elson L. So,Polina Kaplan,Marc R. Nuwer,Nathan B. Fountain,Frank W. Drislane +19 more
TL;DR: There is no uniformly accepted nomenclature for EEG patterns frequently encountered in critically ill patients such as periodic discharges, fluctuating rhythmic patterns, and combinatio.
Journal ArticleDOI
An assessment of nonconvulsive seizures in the intensive care unit using continuous EEG monitoring An investigation of variables associated with mortality
TL;DR: Acute symptomatic cases could not be adequately classified as either absence, simple, or complex partial status epilepticus when the impairment of consciousness arose from the initial illness.
Journal ArticleDOI
Status epilepticus: pathophysiology and management in adults
TL;DR: In this article, the authors identify three phases of generalised convulsive status epilepticus, which they call impending, established, and subtle, and suggest that prehospital treatment is beneficial, that therapeutic drugs should be used in rapid sequence according to a defined protocol, and that refractory status epilepsy should be treated with general anaesthesia.
Journal ArticleDOI
Quantitative continuous EEG for detecting delayed cerebral ischemia in patients with poor-grade subarachnoid hemorrhage
Jan Claassen,Jan Claassen,Lawrence J. Hirsch,Kurt T. Kreiter,Evelyn Y. Du,E. Sander Connolly,Ronald G. Emerson,Stephan A. Mayer +7 more
TL;DR: This post-stimulation qEEG parameter may supplement the clinical exam in poor-grade SAH patients and may prove useful for the detection of DCI, with reasonable specificity.