Critical Care EEG

Neuromonitoring mittels kontinuierlichem EEG (cEEG) kommt bei intensivpflichtigen Patienten immer häufiger zur Anwendung. Mithilfe standardisierter EEG-Kriterien können nichtkonvulsive Anfälle bzw. Status epileptici sowie rhythmische und periodische EEG-Muster unklarer Wertigkeit („ictal-interictal continuum“) verlässlich detektiert und unterschieden werden. Ebenso können mittels cEEG zerebrale Ischämien frühzeitig detektiert, sowie Sedierungs- und Therapiemanagement überwacht und gesteuert werden.

Neuromonitoring by means of continuous EEG (cEEG) has been increasingly used in intensive care patients. Standardized EEG criteria can be used to reliably detect and distinguish nonconvulsive seizures or status epileptici as well as rhythmic and periodic ictal-interictal continuum EEG patterns. Likewise, cerebral ischemia can be detected early by means of cEEG, and sedation and therapy management can be monitored and controlled.

Schlüsselwörter

EEG - kontinuierliches EEG - Intensivstation - nicht-konvulsive Anfälle

Keywords

Status epilepticus - Critical care EEG - ICU - ictal-interictal continuum

Publication History

Article published online:
27 January 2020

• Literatur

• 1 Claassen J, Mayer SA, Kowalski RG. et al. Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology 2004; 62: 1743-1748
• 2 Claassen J, Perotte A, Albers D. et al. Nonconvulsive seizures after subarachnoid hemorrhage: Multimodal detection and outcomes. Ann Neurol 2013; 74: 53-64
• 3 Rodriguez Ruiz A, Vlachy J, Lee JW. et al. Association of Periodic and Rhythmic Electroencephalographic Patterns With Seizures in Critically Ill Patients. JAMA Neurol 2017; 74: 181-188
• 4 Koren J, Herta J, Draschtak S. et al. Early Epileptiform Discharges and Clinical Signs Predict Nonconvulsive Status Epilepticus on Continuous EEG. Neurocrit Care. 2018
• 5 Koren JP, Herta J, Pirker S. et al. Rhythmic and periodic EEG patterns of ‘ictal-interictal uncertainty’ in critically ill neurological patients. Clin Neurophysiol 2016; 127: 1176-1181
• 6 Herman ST, Abend NS, Bleck TP. et al. Consensus statement on continuous EEG in critically ill adults and children, part I: indications. J Clin Neurophysiol 2015; 32: 87-95
• 7 Husain AM, Horn GJ, Jacobson MP. Non-convulsive status epilepticus: usefulness of clinical features in selecting patients for urgent EEG. J Neurol Neurosurg Psychiatry 2003; 74: 189-191
• 8 Seidel S, Aull-Watschinger S, Pataraia E. The yield of routine electroencephalography in the detection of incidental nonconvulsive status epilepticus – a prospective study. Clin Neurophysiol 2012; 123: 459-462
• 9 Sutter R, Semmlack S, Kaplan PW. Nonconvulsive status epilepticus in adults-insights into the invisible. Nat Rev Neurol 2016; 12: 281-293
• 10 Leitinger M, Trinka E, Gardella E. et al. Diagnostic accuracy of the Salzburg EEG criteria for non-convulsive status epilepticus: a retrospective study. The Lancet Neurology 2016; 15: 1054-1062
• 11 Beniczky S, Hirsch LJ, Kaplan PW. et al. Unified EEG terminology and criteria for nonconvulsive status epilepticus. Epilepsia 2013; 54 (Suppl. 6) 28-29
• 12 Young GB, Jordan KG, Doig GS. An assessment of nonconvulsive seizures in the intensive care unit using continuous EEG monitoring: an investigation of variables associated with mortality. Neurology 1996; 47: 83-89
• 13 Chong DJ, Hirsch LJ. Which EEG patterns warrant treatment in the critically ill? Reviewing the evidence for treatment of periodic epileptiform discharges and related patterns. J Clin Neurophysiol 2005; 22: 79-91
• 14 Hirsch LJ, LaRoche SM, Gaspard N. et al. American Clinical Neurophysiology Society’s Standardized Critical Care EEG Terminology: 2012 version. J Clin Neurophysiol 2013; 30: 1-27
• 15 Accolla EA, Kaplan PW, Maeder-Ingvar M. et al. Clinical correlates of frontal intermittent rhythmic delta activity (FIRDA). Clin Neurophysiol 2011; 122: 27-31
• 16 Sutter R, Kaplan PW. Electroencephalographic criteria for nonconvulsive status epilepticus: Synopsis and comprehensive survey. Epilepsia 2012; 53 (Suppl 3): 1-51
• 17 Trinka E, Cock H, Hesdorffer D. et al. A definition and classification of status epilepticus – Report of the ILAE Task Force on Classification of Status Epilepticus. Epilepsia 2015; 56: 1515-1523
• 18 Foreman B, Claassen J. Quantitative EEG for the detection of brain ischemia. Crit Care 2012; 16: 216
• 19 Claassen J, Velazquez A, Meyers E. et al. Bedside quantitative electroencephalography improves assessment of consciousness in comatose subarachnoid hemorrhage patients. Ann Neurol 2016; 80: 541-553
• 20 Witsch J, Frey H-P, Schmidt JM. et al. Electroencephalographic Periodic Discharges and Frequency-Dependent Brain Tissue Hypoxia in Acute Brain Injury. JAMA neurology 2017; 74: 301-309
• 21 Vespa P, Tubi M, Claassen J. et al. Metabolic crisis occurs with seizures and periodic discharges after brain trauma. Ann Neurol 2016; 79: 579-590
• 22 Vespa PM, O’Phelan K, Shah M. et al. Acute seizures after intracerebral hemorrhage: a factor in progressive midline shift and outcome. Neurology 2003; 1441-1446