Continuous EEG Monitoring in the ICU

How do you read something that’s invisible?

An opportunity to take what you learn in med school and implement it in the ICU. Used frequently in the neurocritical care unit, continuous EEG (cEEG) monitoring has proven its effectiveness in diagnosing the cause of consciousness disorders, specifically non-convulsive status epilepticus (NCSE). Since NCSE does not manifest with overt convulsion, EEG interpretation plays an important role in its diagnosis. Moreover, long-term EEG monitoring shows that the EEG patterns of patients with consciousness disorder substantially fluctuate both temporally and spatially.

It is often difficult to determine whether an abnormal EEG pattern occurred during seizure, between seizures or after a seizure. With no established definition or classification of neurocritical EEG, such decisions are often based on the Standardized Critical Care EEG Terminology, proposed by the American Clinical Neurophysiology Society. This classification system simply categorizes EEG patterns observed in the neuro-ICU setting mainly by waveform and localization.

Continuous EEG (cEEG) has been shown to be effective in determining the response and outcome to treatment of non-convulsive status epilepticus (NCSE).  Although continuous EEG (cEEG) monitoring in the ICU is required for correct diagnosis of non-convulsive status epilepticus, there are some difficulties that first need to be overcome, specifically EEG machine capabilities, electrode application, EEG technician and physician staffing difficulties. Digital EEG systems with other quantitative functions, such as amplitude-integrated EEG (aEEG) and DSA, are required for cEEG in the ICU to be able to detect long-term changes in EEG. This can also be correlated with video recordings as well.  Continuous EEG (cEEG) monitoring in the ICU for non-convulsive status epilepticus (NCSE) is also used in stroke patients and in traumatic brain injury (TBI) where both of these conditions are associated with a risk of non-convulsive status epilepticus (NCSE).

 

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https://doi.org/10.1186/s40560-018-0310-z

June 5, 2020
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