Neuroscience: Edited by Marek MirskiThe neuro-ICU patient and electroencephalography paroxysms: if and when to treatRossetti, Andrea Oa; Oddo, Maurob Author Information aDepartments of Neurology, Switzerland bAdult Intensive Care Medicine, University Hospital (CHUV) and Faculty of Biology and Medicine, Lausanne, Switzerland Correspondence to Dr Andrea O. Rossetti, MD, Service de Neurologie, CHUV-BH07, CH-1011 Lausanne, Switzerland Tel: +41 21 314 1220; fax: +41 21 314 1290; e-mail: [email protected] Current Opinion in Critical Care 16(2):p 105-109, April 2010. | DOI: 10.1097/MCC.0b013e3283374b5b Buy Metrics Abstract Purpose of review To review recent clinical data and summarize actual recommendations for the management of electrographic seizures and status epilepticus in neuro-ICU patients. Recent findings 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. Summary We provide a pragmatic approach for the management of electrographic seizures in neuro-ICU patients. International consensus guidelines on continuous electroencephalography monitoring and seizure therapy are needed and would represent the rationale for a future multicenter randomized trial. © 2010 Lippincott Williams & Wilkins, Inc.