RSS-Feed abonnieren
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/s-0039-1693079
Continuous EEG Monitoring in Intensive Care Unit
Publikationsverlauf
Received: 16. Oktober 2018
Accepted after revision: 17. Mai 2019
Publikationsdatum:
31. Juli 2019 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00037682/201802/lookinside/thumbnails/10-1055-s-0039-1693079_00057-1.jpg)
Abstract
Trends of electroencephalogram (EEG) over 24 to 48 hours can help in prognostication in patients. Continuous electroencephalography (cEEG) allows for “real-time” bedside evaluation of cerebral function and can help to monitor patients in intensive care units. Lack of expertise in interpretation of the long-term EEG patterns and controversies in treatment implications have restricted the widespread use of this modality. This review summarizes the indications, techniques, duration, and pitfalls in cEEG monitoring. Compared with routine planned EEG, use of cEEG monitoring increases the sensitivity to detect nonconvulsive seizures (NCS) or nonconvulsive status epilepticus (NCSE) in unresponsive patients with no or subtle clinical signs of seizures. cEEG helps in reducing the overall intensive care unit (ICU) stay by timely detection of possible ischemic or ictal insults, alleviating the need for costlier imaging tests, and by precise drug adjustment in case of SE. However, standardization of the technical terms for wider applicability is needed. Analysis of automated computerized assays in seizure detection and their clinical role and addressing the technical aspects in long-term recordings should be evaluated; cEEG is gaining an important role in the multiparametric neuro-critical care units. Development of defined guidelines for the indications and application of cEEG, technological advances, and ongoing refinements are expected to enhance its utility in clinical practice.
-
References
- 1 Claassen J, Taccone FS, Horn P, Holtkamp M, Stocchetti N, Oddo M. Neurointensive Care Section of the European Society of Intensive Care Medicine. Recommendations on the use of EEG monitoring in critically ill patients: consensus statement from the neurointensive care section of the ESICM. Intensive Care Med 2013; 39 (08) 1337-1351
- 2 Young GB, Mantia J. Continuous EEG monitoring in the intensive care unit. Handb Clin Neurol 2017; 140: 107-116
- 3 Hirsch LJ. Continuous EEG monitoring in the intensive care unit: an overview. J Clin Neurophysiol 2004; 21 (05) 332-340
- 4 DeLorenzo RJ, Waterhouse EJ, Towne AR. et al. Persistent non-convulsive status epilepticus after the control of convulsive status epilepticus. Epilepsia 1998; 39 (08) 833-840
- 5 Kurtz P, Gaspard N, Wahl AS. et al. Continuous electroencephalography in a surgical intensive care unit. Intensive Care Med 2014; 40 (02) 228-234
- 6 Anuhya V, Kunder SK, Madhyastha S. et al. Looking beyond the obvious: cefepime-induced nonconvulsive status epilepticus. J Pharmacol Pharmacother 2017; 8 (03) 145-147
- 7 Synek VM. Prognostically important EEG coma patterns in diffuse anoxic and traumatic encephalopathies in adults. J Clin Neurophysiol 1988; 5 (02) 161-174
- 8 Gaspard N. Current clinical evidence supporting the use of continuous EEG monitoring for delayed cerebral ischemia detection. J Clin Neurophysiol 2016; 33 (03) 211-216
- 9 Vespa PM, Nuwer MR, Juhász C. et al. Early detection of vasospasm after acute subarachnoid hemorrhage using continuous EEG ICU monitoring. Electroencephalogr Clin Neurophysiol 1997; 103 (06) 607-615
- 10 Rosenthal ES, Biswal S, Zafar SF. et al. Continuous electroencephalography predicts delayed cerebral ischemia after subarachnoid hemorrhage: a prospective study of diagnostic accuracy. Ann Neurol 2018; 83 (05) 958-969
- 11 Young GB. The EEG in coma. J Clin Neurophysiol 2000; 17 (05) 473-485
- 12 Karakis I, Montouris GD, Otis JA. et al. A quick and reliable EEG montage for the detection of seizures in the critical care setting. J Clin Neurophysiol 2010; 27 (02) 100-105
- 13 Claassen J, Mayer SA, Kowalski RG, Emerson RG, Hirsch LJ. Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology 2004; 62 (10) 1743-1748
- 14 Herman ST, Abend NS, Bleck TP. et al; Critical Care Continuous EEG Task Force of the American Clinical Neurophysiology Society. Consensus statement on continuous EEG in critically ill adults and children, part I: indications. J Clin Neurophysiol 2015; 32 (02) 87-95
- 15 Crepeau AZ, Fugate JE, Mandrekar J. et al. Value analysis of continuous EEG in patients during therapeutic hypothermia after cardiac arrest. Resuscitation 2014; 85 (06) 785-789
- 16 Bahamon-Dussan JE, Celesia GG, Grigg-Damberger MM. Prognostic significance of EEG triphasic waves in patients with altered state of consciousness. J Clin Neurophysiol 1989; 6 (04) 313-319
- 17 Rodriguez RuizA, Vlachy J, Lee JW. et al; Critical Care EEG Monitoring Research Consortium. Association of periodic and rhythmic electroencephalographic patterns with seizures in critically ill patients. JAMA Neurol 2017; 74 (02) 181-188
- 18 Punia V, Bena J, Krishnan B, Newey C, Hantus S. New onset epilepsy among patients with periodic discharges on continuous electroencephalographic monitoring. Epilepsia 2018; 59 (08) 1612-1620
- 19 Gaspard N, Manganas L, Rampal N, Petroff OA, Hirsch LJ. Similarity of lateralized rhythmic delta activity to periodic lateralized epileptiform discharges in critically ill patients. JAMA Neurol 2013; 70 (10) 1288-1295
- 20 Sivaraju A, Gilmore EJ. Understanding and managing the ictal-interictal continuum in neurocritical care. Curr Treat Options Neurol 2016; 18 (02) 8