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Baseline EEG Pattern on Continuous ICU EEG Monitoring and Incidence of Seizures

Swisher, Christa B.*; Shah, Dharmen*; Sinha, Saurabh R.*,†; Husain, Aatif M.*,†

Journal of Clinical Neurophysiology: April 2015 - Volume 32 - Issue 2 - p 147–151
doi: 10.1097/WNP.0000000000000157
Original Research
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Purpose: To identify the probability of detecting nonconvulsive seizures based on the initial pattern seen in the first 30 minutes of continuous EEG (cEEG) monitoring.

Methods: Continuous EEG monitoring reports from 243 adult patients were reviewed, assessing the baseline cEEG monitoring pattern and the presence of seizures during the entire monitoring period. The baseline EEG patterns were classified into nine categories: seizures, lateralized periodic discharges, generalized periodic discharges, focal epileptiform discharges, burst suppression, asymmetric background, generalized slowing, generalized periodic discharges with triphasic morphology, and normal.

Results: Overall, 51 patients (21%) had nonconvulsive seizures at any time during cEEG monitoring. Notably, 112 patients had generalized slowing as the initial EEG pattern, and none of these patients were noted to have seizures. Seizure rates among the types of baseline EEG findings were as follows: lateralized periodic discharges (56%, n = 9), burst suppression (50%, n = 10), generalized periodic discharges (50%, n = 2), normal (33%, n = 3), focal epileptiform discharges (31%, n = 35), and asymmetric background (11%, n = 46).

Conclusions: Patients with only generalized slowing seen on the baseline EEG recording are unlikely to develop seizures on subsequent cEEG monitoring. Depending on the clinical circumstance, the standard duration of cEEG recording (24–48 hours) may be unnecessary in patients with generalized slowing as their only cEEG abnormality.

*Department of Neurology, Duke University Medical Center, Durham, North Carolina, U.S.A.; and

Neurodiagnostic Center, Veterans Affairs Medical Center, Durham, North Carolina, U.S.A.

Address correspondence and reprint requests to Aatif M. Husain, MD, 299B Hanes House, 330 Trent Drive, Box 102350 Duke University Medical Center, Durham, NC 27710, U.S.A.; e-mail: aatif.husain@dm.duke.edu.

Presented as a poster at the American Clinical Neurophysiology Society Meeting, Miami, Florida, U.S.A., February 2013.

© 2015 by the American Clinical Neurophysiology Society