The neuro-ICU patient and electroencephalography paroxysms: if and when to treat

Current Opinion in Critical Care
Andrea O Rossetti, Mauro Oddo

Abstract

To review recent clinical data and summarize actual recommendations for the management of electrographic seizures and status epilepticus in neuro-ICU patients. Electrographic, 'nonconvulsive', seizures are frequent in neuro-ICU patients including traumatic brain injury, subarachnoid hemorrhage, intracerebral hemorrhage and hypoxic-ischemic encephalopathy. Continuous electroencephalography monitoring is thus of great potential utility. The impact of electrographic seizures on outcome however is not entirely established and it is also unclear what type of electroencephalography paroxysms require treatment and when and how exactly to treat them. Evidence from randomized studies is lacking and will not be available in the near future. Given robust animal and human evidence showing the potential negative impact of seizures on secondary cerebral damage and outcome, treatment of seizures appears reasonable, particularly if related to status epilepticus. On the contrary, over-aggressive antiepileptic therapy entails risks. The management of seizures should therefore be guided individually, based on the underlying cause, the severity of illness and patient comorbidities. We provide a pragmatic approach for the management of electrograph...Continue Reading

References

Aug 23, 1990·The New England Journal of Medicine·N R TemkinH R Winn
Feb 1, 1994·Annals of Neurology·E F WijdicksF W Sharbrough
Oct 9, 2002·Epilepsia·Stefano PasseroGiampaolo Vatti
Jan 15, 2003·Neurology·Bernard S ChangUNKNOWN Quality Standards Subcommittee of the American Academy of Neurology
Apr 5, 2005·Journal of Clinical Neurophysiology : Official Publication of the American Electroencephalographic Society·Derek J Chong, Lawrence J Hirsch
Apr 5, 2005·Journal of Clinical Neurophysiology : Official Publication of the American Electroencephalographic Society·Lewis L Kull, Ronald G Emerson
Nov 16, 2005·Archives of Neurology·Andrea O RossettiEdward B Bromfield
Jan 13, 2006·Neurology·E G J ZandbergenUNKNOWN PROPAC Study Group
May 26, 2006·European Journal of Neurology : the Official Journal of the European Federation of Neurological Societies·H MeierkordM Holtkamp
Oct 19, 2006·Epilepsia·Kenneth G Jordan, Lawrence J Hirsch
Mar 17, 2007·Acta Neurologica Scandinavica·J W Y ChenC G Wasterlain
May 22, 2007·Journal of Neurotrauma·Susan L BrattonDavid W Wright
Aug 19, 2007·Journal of Neurosurgery·Axel J RosengartR Loch Macdonald
Mar 8, 2008·European Journal of Neurology : the Official Journal of the European Federation of Neurological Societies·Y-J LinC-H Lu
Aug 5, 2008·Journal of Clinical Neurophysiology : Official Publication of the American Electroencephalographic Society·Frank W DrislaneDonald L Schomer
Sep 5, 2008·Journal of Neurology·Andrea O RossettiEdward B Bromfield
Mar 24, 2009·Journal of Neurosurgery·Tzu-Ming YangCheng-Hsien Lu
Mar 26, 2009·Neurocritical Care·Steven R MesséUNKNOWN CHANT investigators
May 27, 2009·Neurophysiologie clinique = Clinical neurophysiology·A AmantiniF Pinto
Jul 18, 2009·Anesthesia and Analgesia·Daniel FriedmanLawrence J Hirsch
Aug 7, 2009·The New England Journal of Medicine·G Bryan Young
Oct 3, 2009·Stroke; a Journal of Cerebral Circulation·Andrew M NaidechH Hunt Batjer
Oct 30, 2009·Seizure : the Journal of the British Epilepsy Association·Dharmen Shah, Aatif M Husain
Oct 31, 2009·Critical Care : the Official Journal of the Critical Care Forum·Russel J RobertsJohn W Devlin

❮ Previous
Next ❯

Citations

Jul 28, 2012·Current Neurology and Neuroscience Reports·L A Urbano, Mauro Oddo
Apr 28, 2011·Neurocritical Care·Soojin ParkScott E Kasner
Oct 6, 2010·Critical Care : the Official Journal of the Critical Care Forum·Andrea O RossettiMauro Oddo
Mar 15, 2016·Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology·Valia RodríguezSuzette M LaRoche
Jan 31, 2012·Neurologic Clinics·William David Freeman, Maria I Aguilar
Sep 24, 2011·Lancet Neurology·Andrea O Rossetti, Daniel H Lowenstein
Apr 16, 2011·World Neurosurgery·R Loch Macdonald
Jul 8, 2015·Epilepsy & Behavior : E&B·Eugen Trinka, Markus Leitinger
Aug 19, 2015·Therapeutic Hypothermia and Temperature Management·Teresa WavraSarah L Livesay
Apr 27, 2017·Journal of Veterinary Emergency and Critical Care·Susan Blades Golubovic, John H Rossmeisl
Jun 13, 2017·Cerebrovascular Diseases·Fabricio O LimaLi L Min
Jun 3, 2011·Journal of Clinical Neurophysiology : Official Publication of the American Electroencephalographic Society·Peter W Kaplan, Andrea O Rossetti
Feb 25, 2011·Current Opinion in Critical Care·Mauro Oddo, Andrea O Rossetti

❮ Previous
Next ❯

Related Concepts

Related Feeds

Brain Ischemia

Brain ischemia is a condition in which there is insufficient blood flow to the brain to meet metabolic demand. Discover the latest research on brain ischemia here.

Brain Injury & Trauma

brain injury after impact to the head is due to both immediate mechanical effects and delayed responses of neural tissues.