scholarly journals Periodic EEG Patterns in the Intensive Care Unit (ICU): Definition, Recognition and Clinical Significance

2021 ◽  
Author(s):  
Boulenouar Mesraoua ◽  
Musab Abdalhalim Ali ◽  
Rola Hosni Mohamed Hashem Khodair ◽  
Yazan Nofal ◽  
Dirk Theophiel O. Deleu ◽  
...  
Keyword(s):  
Altered Mental Status ◽  
Unstable State ◽  
Eeg Monitoring ◽  
Electrical Discharges ◽  
Periodic Discharges ◽  
Delta Activity ◽  
Interictal Eeg ◽  
Rhythmic Delta Activity ◽  
Eeg Features

Periodic electroencephalographic (EEG) patterns are frequently recorded during ICU EEG monitoring in patients with altered mental status; these EEG features represent electrical discharges, ictal in appearance, occuring at regular intervals. They are known as lateralized periodic discharges (LPDs), bilateral independent periodic discharges (BIPDS), generalized periodic discharges (GPDs), continuous 2/s GPDs with triphasic morphology or triphasic waves (TWs) and Stimulus Induced Evolving Lateralized Rhytmic delta activity or Si-Evolving LRDA (previously SIRPIDS); other periodic, rhythmic patterns are Occasional frontally predominant brief 2/s GRDA (FIRDA previously), Lateralized rhythmic delta activity (LRDA) and Brief potentially ictal rhythmic discharges or B (I)RDs. The role of most (not all) of these EEG patterns is controversial; there is no consensus on which patterns are associated with ongoing seizure injury, which patterns need to be treated, and how aggressively they should be treated. Many authors consider these patterns as an unstable state on an ictal-interictal EEG continuum; the aim of the present chapter is to gain knowledge of these EEG features, show their association with known neurologic pathologies/syndromes and finally how to manage them.

Neuroimaging Correlates of Lateralized Rhythmic Delta Activity, Lateralized Periodic Discharges, and Generalized Rhythmic Delta Activity on EEG in Critically Ill Patients

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Mohamed Alzawahmah ◽  
Michael W.K. Fong ◽  
Emily J. Gilmore ◽  
Lawrence J. Hirsch
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Periodic Discharges ◽  
Delta Activity ◽  
Rhythmic Delta Activity

Frontal Intermittent Rhythmic Delta Activity (FIRDA) in the Neurological Intensive Care: Prevalence, Determinants, and Clinical Significance

2017 ◽  
Vol 49 (4) ◽  
pp. 272-277 ◽  
Author(s):  
Nese Dericioglu ◽  
Farid Khasiyev ◽  
E. Murat Arsava ◽  
M. Akif Topcuoglu
Keyword(s):  
Intensive Care ◽  
Clinical Significance ◽  
Care Setting ◽  
Eeg Monitoring ◽  
Metabolic Disturbances ◽  
Cerebral Lesions ◽  
Neurological Intensive Care ◽  
Delta Activity ◽  
Rhythmic Delta Activity ◽  
Video Eeg

Introduction. Frontal intermittent rhythmic delta activity (FIRDA), a transient rhythmic slow wave pattern over the anterior EEG leads, has been reported in a wide variety of cerebral lesions and different metabolic disturbances. Few authors have analyzed the frequency and clinical significance of FIRDA in the critical care setting. We aimed to better understand these issues in our intensive care cohort and if possible, try to delineate its underlying mechanisms. Methods. Video-EEG reports of consecutive adult patients in the neurological intensive care unit (NICU) since 2009 were retrospectively reviewed to identify cases with FIRDA. Demographic, clinical, and laboratory data were obtained from EEG reports and patient charts. Age- and sex-matched patients with acute stroke, hospitalized in NICU and no FIRDA on video-EEG monitoring served as the control group. Results. Among 162 patients who underwent video-EEG monitoring, FIRDA was documented in 17%. Female prevalence was 50% and age ranged from 23 to 82 years. Twenty-three (82%) of patients with FIRDA had a diagnosis of stroke. Comparison of demographic characteristics, EEG findings, metabolic disturbances and prognoses revealed no differences between stroke cases with and without FIRDA, except for higher frequency of acute and chronic isolated posterior circulation infarcts in patients with FIRDA. Conclusion. FIRDA is more commonly encountered in the neurocritical care setting as compared with outpatient EEG clinics. Our findings in stroke patients indicate that involved vascular territories may be related to the generation of FIRDA.

scholarly journals Hyperperfusion in the thalamus on arterial spin labeling indicates non-convulsive status epilepticus

2020 ◽  
Author(s):  
Satoru Ohtomo ◽  
Hiroshi Otsubo ◽  
Hiroaki Arai ◽  
Yoshiteru Shimoda ◽  
Yoichiro Homma ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Critically Ill Patients ◽  
Arterial Spin Labeling ◽  
Spin Labeling ◽  
Convulsive Status Epilepticus ◽  
Impaired Consciousness ◽  
Periodic Discharges ◽  
Epileptiform Discharges ◽  
Delta Activity ◽  
Rhythmic Delta Activity

Abstract Non-convulsive status epilepticus describes the syndrome of unexplained impaired consciousness in critically ill patients. Non-convulsive status epilepticus is very likely to lead to delayed diagnosis and poor outcomes because of the absence of convulsive symptoms. EEG is essential for the diagnosis of non-convulsive status epilepticus to establish the association between periodic discharges and rhythmic delta activity in addition to ictal epileptiform discharges according to the Salzburg criteria. Arterial spin labeling, a type of perfusion MRI, has been applied for rapid and non-invasive evaluation of the ictal state. Ictal cerebral cortical hyperperfusion is the most common finding to demonstrate focal onset seizures. Hyperperfusion of the thalamus on single photon emission computed tomography was found in patients with impaired awareness seizures. We hypothesized that thalamocortical hyperperfusion on arterial spin labeling identifies non-convulsive status epilepticus and such thalamic hyperperfusion specifically associates with periodic/rhythmic discharges producing impaired consciousness without convulsion. We identified 27 patients (17 females; age 58-91 years) who underwent both arterial spin labeling and EEG within 24 hours of suspected non-convulsive status epilepticus. We analyzed 28 episodes of suspected non-convulsive status epilepticus and compared hyperperfusion on arterial spin labeling with periodic/rhythmic discharges. We evaluated 21 episodes as a positive diagnosis of non-convulsive status epilepticus according to the Salzburg criteria. We identified periodic discharges in 15 (12 lateralized and three bilateral independent) episodes and rhythmic delta activity in 13 (10 lateralized, one bilateral independent, two generalized) episodes. Arterial spin labeling showed thalamic hyperperfusion in 16 (11 unilateral, 5 bilateral) episodes and cerebral cortical hyperperfusion in 24 (20 unilateral, 4 bilateral) episodes. Thalamic hyperperfusion was significantly associated with non-convulsive status epilepticus (P = 0.0007; sensitivity, 76.2%; specificity, 100%), periodic discharges (P < 0.0001; 93.3%; 84.6%), and rhythmic delta activity (P = 0.0006; 92.3%; 73.3%). Cerebral cortical hyperperfusion was significantly associated with non-convulsive status epilepticus (P = 0.0017; 100%; 57.1%) and periodic discharges (P = 0.0349; 100%; 30.8%), but not with rhythmic delta activity. Thalamocortical hyperperfusion could be a new biomarker of non-convulsive status epilepticus according to the Salzburg criteria in critically ill patients. Specific thalamic hyperexcitability might modulate the periodic discharges and rhythmic delta activity associated with non-convulsive status epilepticus. Impaired consciousness without convulsions could be caused by predominant thalamic hyperperfusion together with cortical hyperperfusion but without ictal epileptiform discharges.

Abstract TMP22: Dynamic Worsening of Epileptiform Abnormalities Following Subarachnoid Hemorrhage is Associated With Poor 3-Month Outcomes

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
India A Lissak ◽  
Sahar F Zafar ◽  
Kasey Anderson ◽  
Jennifer A Kim ◽  
M. Brandon Westover ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Delayed Cerebral Ischemia ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Periodic Discharges ◽  
Epileptiform Discharges ◽  
Delta Activity ◽  
Rhythmic Delta Activity ◽  
Cortical Dysfunction

Objective: Worsening epileptiform abnormalities (EAs) and deteriorating background activity are common continuous electroencephalography (cEEG) patterns that predict subsequent clinical deterioration following subarachnoid hemorrhage (SAH). While worsening EAs and background deterioration both imply cortical dysfunction, we sought to clarify if these patterns have a different association with clinical outcomes. Methods: We enrolled patients with SAH undergoing > 3 days of cEEG monitoring enrolled in a prospective outcome study with a modified Rankin Scale (mRS) assessment at 3 months. Worsening EAs included new or increasing burden of sporadic epileptiform discharges, lateralized rhythmic delta activity (LRDA), lateralized periodic discharges (LPD), or generalized periodic discharges (GPD). Background deterioration was defined as decreasing Alpha Delta Ratio (ADR), Relative Alpha Variability (RAV) or worsening focal slowing. We evaluated the association between these cEEG patterns and 3-month mRS >3 and examined whether the influence on outcome was independent of delayed cerebral ischemia (DCI). Results: Of 59 patients meeting inclusion criteria (3-month mRS median 3 [IQR 1-5]), worsening EAs developed in 23 (39%) and new background deterioration in 24 (41%), whereas 24 patients (41%) developed neither finding and 12 (20%) developed both. Patients with worsening EAs were more likely to have a poor 3-month mRS compared to those without worsening EAs (OR 6.44; 95%CI 1.99-20.9; p=0.001). Developing new background deterioration was not significantly associated with poor 3-month outcome (OR 1.56, 95%CI 0.53-4.59; p=0.42). There was no additive effect on poor outcome of developing both findings. In a multivariate logistic regression, the effect of worsening EAs on 3-month mRS was independent of DCI. Interpretation: While both worsening EAs and new background deterioration have previously been associated with DCI, only worsening EAs influences poor long-term outcome. Further investigation may clarify if distinct mechanisms underlie these differences.

Adult EEG

2016 ◽  
pp. 97-109
Author(s):  
Katherine H. Noe ◽  
Joseph F. Drazkowski
Keyword(s):  
Epileptiform Activity ◽  
Sharp Waves ◽  
Epileptiform Discharges ◽  
Inappropriate Treatment ◽  
Delta Activity ◽  
Epilepsy Diagnosis ◽  
Interictal Eeg ◽  
Eeg Recordings ◽  
Rhythmic Delta Activity ◽  
Normal Background

Epileptiform discharges present on routine EEG recordings highly correlate with a tendency for clinical seizures. When present, they can help confirm a diagnosis of epilepsy and classify epilepsy type, localization, and syndrome. EEG’s sensitivity for detecting epileptiform activity depends on many factors, including the site of seizure origin and seizure frequency. Even in persons with known epilepsy, a routine EEG can often be normal; thus a normal interictal EEG should not be used to exclude an epilepsy diagnosis. Misinterpretation or “over-reading” of artifacts and normal background activity on the EEG as epileptiform is common by inexperienced readers. Unfortunately, this can lead to misdiagnosis and inappropriate treatment. The EEG reader should be familiar with the commonly encountered epileptiform patterns of generalized spike and wave, generalized slow spike and wave, generalized paroxysmal fast activity, focal spike and sharp waves, and temporal intermittent rhythmic delta activity.

Generalized Rhythmic Delta Activity Frontally Predominant Differentiates Dementia With Lewy Bodies From Alzheimer's Disease and Parkinson's Disease Dementia: A Conventional Electroencephalography Visual Analysis

2021 ◽  
pp. 155005942199714
Author(s):  
Lucia Zinno ◽  
Anna Negrotti ◽  
Chiara Falzoi ◽  
Giovanni Messa ◽  
Matteo Goldoni ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Parkinson’S Disease ◽  
Alzheimer's Disease ◽  
Parkinson's Disease ◽  
Cognitive Impairment ◽  
Dementia With Lewy Bodies ◽  
Visual Analysis ◽  
Lewy Bodies ◽  
Delta Activity ◽  
Rhythmic Delta Activity

Introduction. An easily accessible and inexpensive neurophysiological technique such as conventional electroencephalography may provide an accurate and generally applicable biomarker capable of differentiating dementia with Lewy bodies (DLB) from Alzheimer’s disease (AD) and Parkinson’s disease-associated dementia (PDD). Method. We carried out a retrospective visual analysis of resting-state electroencephalography (EEG) recording of 22 patients with a clinical diagnosis of 19 probable and 3 possible DLB, 22 patients with probable AD and 21 with PDD, matched for age, duration, and severity of cognitive impairment. Results. By using the grand total EEG scoring method, the total score and generalized rhythmic delta activity frontally predominant (GRDAfp) alone or, even better, coupled with a slowing of frequency of background activity (FBA) and its reduced reactivity differentiated DLB from AD at an individual level with an high accuracy similar to that obtained with quantitative EEG (qEEG). GRDAfp alone could also differentiate DLB from PDD with a similar level of diagnostic accuracy. AD differed from PDD only for a slowing of FBA. The duration and severity of cognitive impairment did not differ between DLB patients with and without GRDAfp, indicating that this abnormal EEG pattern should not be regarded as a disease progression marker. Conclusions. The findings of this investigation revalorize the role of conventional EEG in the diagnostic workup of degenerative dementias suggesting the potential inclusion of GRDAfp alone or better coupled with the slowing of FBA and its reduced reactivity, in the list of supportive diagnostic biomarkers of DLB.

scholarly journals Continuous EEG Monitoring in the Intensive Care Unit

1998 ◽  
Vol 25 (S1) ◽  
pp. S12-S15 ◽  
Author(s):  
John Kay
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Eeg Monitoring ◽  
General Icus ◽  
Continuous Eeg ◽  
Nonconvulsive Seizures ◽  
Continuous Eeg Monitoring ◽  
Clinical Problems

AbstractBackground:Electroencephalography (EEG) is playing an increasingly important role in the management of comatose patients in the intensive care unit.Methods:The techniques of EEG monitoring are reviewed. Initially, standard, discontinuous recordings were performed in intensive care units (ICUs). Later, continuous displays of “raw EEG” (CEEG) were used. More recently, the addition of quantitative techniques allowed for more effective reading.Results and Conclusions:Applications of continuous EEG to clinical problems are discussed. The most useful role of CEEG appears to be the detection and management of nonconvulsive seizures. There is a need for controlled studies to assess the role for CEEG in neuro-ICUs and general ICUs.

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