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Ictal–Interictal Continuum

Kalamangalam, Giridhar P.*; Pohlmann-Eden, Bernhard

Journal of Clinical Neurophysiology: July 2018 - Volume 35 - Issue 4 - p 274–278
doi: 10.1097/WNP.0000000000000447
Invited Review

Summary: The term “ictal–interictal” continuum has seen wide adoption in the critical care EEG domain, referring to the presence of abnormal periodic activity on the scalp EEG variably associated with seizures. The historical origin of the ictal–interictal continuum concept is discussed with a review of known and surmised physiological mechanisms for their origin and relationship to seizures. Therapeutic approaches to patients exhibiting ictal–interictal continuum EEG patterns are reviewed, and some open scientific questions highlighted. Further understanding of the ictal–interictal continuum is likely to significantly improve the care of the critically ill neurological patient.

*Department of Neurology, University of Florida, Gainesville, Florida, U.S.A.; and

Brain Repair Center, Life Science Research Institute, Dalhousie University, Halifax, NS, Canada.

Address correspondence and reprint requests to Giridhar P. Kalamangalam, MD, DPhil, Department of Neurology, University of Florida, PO Box 100236, Gainesville, FL 32610, U.S.A.; e-mail:

The authors have no conflicts of interest to disclose.

G. P. Kalamangalam acknowledges an NIH career development award (K23NS079900-05).

© 2018 by the American Clinical Neurophysiology Society