Skip to main content
AAN.com
×
Site maintenance Tuesday, May 28, 2024. Please note that new registrations and purchases will be unavailable on this date.
Articles
May 24, 2004

Detection of electrographic seizures with continuous EEG monitoring in critically ill patients

May 25, 2004 issue
62 (10) 1743-1748

Abstract

Objective: To identify patients most likely to have seizures documented on continuous EEG (cEEG) monitoring and patients who require more prolonged cEEG to record the first seizure.
Methods: Five hundred seventy consecutive patients who underwent cEEG monitoring over a 6.5-year period were reviewed for the detection of subclinical seizures or evaluation of unexplained decrease in level of consciousness. Baseline demographic, clinical, and EEG findings were recorded and a multivariate logistic regression analysis performed to identify factors associated with 1) any EEG seizure activity and 2) first seizure detected after >24 hours of monitoring.
Results: Seizures were detected in 19% (n = 110) of patients who underwent cEEG monitoring; the seizures were exclusively nonconvulsive in 92% (n = 101) of these patients. Among patients with seizures, 89% (n = 98) were in intensive care units at the time of monitoring. Electrographic seizures were associated with coma (odds ratio [OR] 7.7, 95% CI 4.2 to 14.2), age <18 years (OR 6.7, 95% CI 2.8 to 16.2), a history of epilepsy (OR 2.7, 95% CI 1.3 to 5.5), and convulsive seizures during the current illness prior to monitoring (OR 2.4, 95% CI 1.4 to 4.3). Seizures were detected within the first 24 hours of cEEG monitoring in 88% of all patients who would eventually have seizures detected by cEEG. In another 5% (n = 6), the first seizure was recorded on monitoring day 2, and in 7% (n = 8), the first seizure was detected after 48 hours of monitoring. Comatose patients were more likely to have their first seizure recorded after >24 hours of monitoring (20% vs 5% of noncomatose patients; OR 4.5, p = 0.018).
Conclusions: CEEG monitoring detected seizure activity in 19% of patients, and the seizures were almost always nonconvulsive. Coma, age <18 years, a history of epilepsy, and convulsive seizures prior to monitoring were risk factors for electrographic seizures. Comatose patients frequently required >24 hours of monitoring to detect the first electrographic seizure.

Get full access to this article

View all available purchase options and get full access to this article.

References

1.
Jordan KG. Nonconvulsive seizures (NCS) and nonconvulsive status epilepticus (NCSE) detected by continuous EEG monitoring in the neuro ICU. Neurology. 1992; 42: 180. Abstract.
2.
Towne AR, Waterhouse EJ, Boggs JG, et al. Prevalence of nonconvulsive status epilepticus in comatose patients. Neurology. 2000; 54: 340–345.
3.
Privitera M, Hoffman M, Moore JL, Jester D. EEG detection of nontonic-clonic status epilepticus in patients with altered consciousness. Epilepsy Res. 1994; 18: 155–166.
4.
DeLorenzo RJ, Waterhouse EJ, Towne AR, et al. Persistent nonconvulsive status epilepticus after the control of convulsive status epilepticus. Epilepsia. 1998; 39: 833–840.
5.
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: 750–756.
6.
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.
7.
Treiman DM, Meyers PD, Walton NY, et al. A comparison of four treatments for generalized convulsive status epilepticus. Veterans Affairs Status Epilepticus Cooperative Study Group. N Engl J Med. 1998; 339: 792–798.
8.
Jordan KG. Continuous EEG and evoked potential monitoring in the neuroscience intensive care unit. J Clin Neurophysiol. 1993; 10: 445. Abstract.
9.
Mayer SA, Claassen J, Lokin J, Fitzsimmons BF, Mendehlson F. Predictors of refractory status epilepticus. Arch Neurol. 2002; 59: 205–210.
10.
Bleck TP. Advances in the management of refractory status epilepticus. Crit Care Med. 1993; 21: 955–957.
11.
Claassen J, Hirsch LJ, Emerson RG, Bates JE, Thompson TB, Mayer SA. Continuous EEG monitoring and midazolam infusion for refractory nonconvulsive status epilepticus. Neurology. 2001; 57: 1036–1042.
12.
Treiman DM. Electroclinical features of status epilepticus. J Clin Neurophysiol. 1995; 12: 343–362.
13.
Garzon E, Fernandes RM, Sakamoto AC. Serial EEG during human status epilepticus: evidence for PLED as an ictal pattern. Neurology. 2001; 57: 1175–1183.
14.
Jaitly R, Sgro JA, Towne AR, Ko D, DeLorenzo RJ. Prognostic value of EEG monitoring after status epilepticus: a prospective adult study. J Clin Neurophysiol. 1997; 14: 326–334.
15.
Nei M, Lee J-M, Shanker VL, Sperling MR. The EEG and prognosis in status epilepticus. Epilepsia. 1999; 40: 157–163.

Information & Authors

Information

Published In

Neurology®
Volume 62Number 10May 25, 2004
Pages: 1743-1748
PubMed: 15159471

Publication History

Received: September 25, 2003
Accepted: January 26, 2004
Published online: May 24, 2004
Published in print: May 25, 2004

Permissions

Request permissions for this article.

Authors

Affiliations & Disclosures

J. Claassen, MD
From the Division of Critical Care Neurology (Drs. Claassen and Mayer, R.G. Kowalski) and Comprehensive Epilepsy Center (Drs. Claassen, Emerson, and Hirsch), Department of Neurology, College of Physicians and Surgeons, Columbia University, New York.
S. A. Mayer, MD
From the Division of Critical Care Neurology (Drs. Claassen and Mayer, R.G. Kowalski) and Comprehensive Epilepsy Center (Drs. Claassen, Emerson, and Hirsch), Department of Neurology, College of Physicians and Surgeons, Columbia University, New York.
R. G. Kowalski, BS
From the Division of Critical Care Neurology (Drs. Claassen and Mayer, R.G. Kowalski) and Comprehensive Epilepsy Center (Drs. Claassen, Emerson, and Hirsch), Department of Neurology, College of Physicians and Surgeons, Columbia University, New York.
R. G. Emerson, MD
From the Division of Critical Care Neurology (Drs. Claassen and Mayer, R.G. Kowalski) and Comprehensive Epilepsy Center (Drs. Claassen, Emerson, and Hirsch), Department of Neurology, College of Physicians and Surgeons, Columbia University, New York.
L. J. Hirsch, MD
From the Division of Critical Care Neurology (Drs. Claassen and Mayer, R.G. Kowalski) and Comprehensive Epilepsy Center (Drs. Claassen, Emerson, and Hirsch), Department of Neurology, College of Physicians and Surgeons, Columbia University, New York.

Notes

Address correspondence and reprint requests to Dr. J. Claassen, Division of Critical Care Neurology, Neurologic Institute, 710 W. 168 St., Unit 1, New York, NY 10032; e-mail: [email protected]

Metrics & Citations

Metrics

Citations

Download Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Select your manager software from the list below and click Download.

Cited By
  1. Pathophysiology, Diagnosis, Prognosis, and Prevention of Poststroke Epilepsy, Neurology, 102, 11, (2024)./doi/10.1212/WNL.0000000000209450
    Abstract
  2. Characteristics and Attendance of Patients Eligible for the PASS Clinic, Neurology Clinical Practice, 14, 1, (2024)./doi/10.1212/CPJ.0000000000200232
    Abstract
  3. Evaluation and Management of Disorders of Consciousness in the Acute Care Setting, Physical Medicine and Rehabilitation Clinics of North America, 35, 1, (79-92), (2024).https://doi.org/10.1016/j.pmr.2023.06.013
    Crossref
  4. Impact of Listening to Indian Classical Music, or Rāgas, on the Electroencephalogram: A Meta-Analysis, Cureus, (2023).https://doi.org/10.7759/cureus.49592
    Crossref
  5. Epileptic seizures and epilepsy in children after stroke, L.O. Badalyan Neurological Journal, 4, 1, (29-42), (2023).https://doi.org/10.46563/2686-8997-2023-4-1-29-42
    Crossref
  6. A Characterization of Neurology Consults for Inpatients with SARS-CoV-2 Infection Compared to Other Respiratory Viruses, Neurology International, 15, 4, (1393-1402), (2023).https://doi.org/10.3390/neurolint15040089
    Crossref
  7. Non-Convulsive Status Epilepticus in Aneurysmal Subarachnoid Hemorrhage: A Prognostic Parameter, Brain Sciences, 13, 2, (184), (2023).https://doi.org/10.3390/brainsci13020184
    Crossref
  8. The association between epilepsy and COVID-19: analysis based on Mendelian randomization and FUMA, Frontiers in Neuroscience, 17, (2023).https://doi.org/10.3389/fnins.2023.1235822
    Crossref
  9. Editorial: Acute symptomatic seizures and epileptiform abnormalities: Management and outcomes, Frontiers in Neurology, 14, (2023).https://doi.org/10.3389/fneur.2023.1185710
    Crossref
  10. Multimodal monitoring: practical recommendations (dos and don'ts) in challenging situations and uncertainty, Frontiers in Neurology, 14, (2023).https://doi.org/10.3389/fneur.2023.1135406
    Crossref
  11. See more
Loading...

View Options

Get Access

Login options

Check if you have access through your login credentials or your institution to get full access on this article.

Personal login Institutional Login
Purchase Options

Purchase this article to get full access to it.

Purchase Access, $39 for 24hr of access

View options

Full Text

View Full Text

Full Text HTML

View Full Text HTML

Media

Figures

Other

Tables

Share

Share

Share article link

Share