Continuous EEG monitoring in ICU

Over time advances in EEG technology have ushered in successive revolutions in the uses of EEG and the type of clinical information provided by EEG. In our current moment, the introduction of artificial intelligence, promises to drive yet another revolution in the use of EEG. Indeed, the impact of AI will be felt across clinical care in epilepsy. In this talk, we consider the current state of EEG in clinical use, reflect on how EEG has changed up to this moment, and discuss how AI will vastly reshape how EEG is used and interpreted.

Learning Objectives:

• Understand how advances in EEG technology have broadened the uses of EEG in past and present.
• Understand how the application of AI tools to EEG will further drive and broaden the uses of EEG
• Understand the role of the epileptologist in the interpretation of EEG.

ASET approval for 1.0 CEC

Ripples (80-200 Hz) and Fast Ripples (200-600 Hz) are brief (15-200 msec) bursts of spectral energy that can occur superimposed on inter-ictal or ictal epileptiform spikes or superimposed on the EEG background. Both ripples and fast ripples may delineate regions that are necessary and sufficient for seizures known as the epileptogenic zone and correspond with disease severity. Natus® BRAIN QUICK® can visualize ripples and fast ripples and distinguish these events from artifact. BRAIN QUICK plug-ins can quantify and automatically annotate each ripple, fast ripple, and spike event for higher-level custom analysis approaches using Python or Matlab.

Learning Objectives:

• Ripples (80-200 Hz) and fast ripples (200-600 Hz) occur superimposed on epileptiform spikes or the EEG background in scalp EEG, intracranial EEG, and the local field potential.
• Ripples that occur on the EEG background may be an admixture of normal and pathological events. Ripples superimposed on epileptiform spikes and fast ripples found in the EEG background or superimposed on epileptiform spikes are most often pathological events.
• Identifying ripples and fast ripples should be performed during non-REM sleep, during wakefulness muscle artifact can lead to false ripple and fast ripple detections. Software can be used to validate the detections and make redactions.
• Fast ripples may indicate the synchronization of pathological neuron clusters that can prime epileptiform spikes and seizures. Data show that surgeries that target fast ripple correlate with seizure free post-operative seizure outcome.

ASET approval for 1.0 CEC

When managing a child with focal epilepsy, the focus is on localizing the epileptogenic zone. In this seminar, we will explore how to analyze seizure videos—whether brought by parents or recorded during video-EEG monitoring—to formulate hypotheses regarding the seizure onset zone. In pediatrics, we often face challenges such as the child’s difficulty in expressing subjective symptoms, as well as behavioral disorders or developmental delays, which can make it difficult to distinguish ictal events from non-epileptic behavioral episodes. We will discuss how symptom analysis can help differentiate between epileptic and behavioral disturbances.

Learning Objectives:

• Understanding the clinical and radiological correlations of seizures
• Understanding the unique aspects of pediatric seizure semiology
• To be able to use video analysis as part of the presurgical workup
• To effectively interact with young or developmentally delayed children during seizures

ASET approval for 1.0 CEC – pending