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| |  Intracortical EEG Most Effective for Monitoring Seizure Activity in ICU NEW YORK -- June 17, 2009 -- Two new studies published in Annals of Neurology and Critical Care Medicine demonstrate a need for more vigilant monitoring for seizure activity among intensive care patients who may be experiencing subtle seizures that are typically unrecognised. These subtle seizures may be affecting patients’ prognoses and causing long-term brain damage, death, and severe disability. Both studies, led by Lawrence J. Hirsch, MD, Columbia University Medical Center, and Continuous EEG Monitoring Program at the Comprehensive Epilepsy Center at NewYork-Presbyterian Hospital/Columbia, New York, New York, found that electroencephalography (EEG) was effective in detecting subtle seizures that are often impossible to detect by visual observation. The findings demonstrated the value of continuous EEG and intracranial EEG (ICE). “Monitoring for seizure activity in intensive care patients is important in order to identify small, clinically invisible seizures, which might explain why patients are not waking up -- namely, because they are having lots of mini-seizures in multiple locations,” said Dr. Hirsch. “Treating these clinically silent seizures may lead to improved alertness, reverse ongoing brain dysfunction, and prevent progressive injury to brain cells. Intracortical electroencephalography appears to be the preferred method to monitor seizure activity in patients requiring other invasive brain monitoring, as it provides better, real-time brain monitoring, while patients in the Medical [intensive care unit] should receive continuous EEG monitoring with standard, noninvasive electrodes.” The study appearing in the Annals of Neurology compared the use of standard scalp EEG monitoring in neonative intensive care unit (NICU) patients with ICE monitoring. ICE was found to detect small seizures occurring within the patient’s brain that the continuous EEG could not detect. ICE was also helpful in detecting ischaemia and bleeding as soon as they occurred, and prior to detection by clinical exam or other monitoring methods. The study appearing in the journal Critical Care Medicine examined continuous EEG monitoring in the Medical ICU (MICU) in patients with no known primary brain abnormality. Using continuous EEG monitoring, researchers found that seizures, and nearly continuous spikes that are related to seizures, were common among patients in the MICU, especially patients with sepsis. The majority of seizures were non-convulsive. This may help explain the enigmatic condition of sepsis-associated encephalopathy. “Treating certain ICU patients with anti-seizure medications might help prevent neuronal damage, reduce length of stay in the ICU and help patients wake-up sooner,” said Dr. Hirsch. “Additional research is needed to determine the exact prevalence and impact of seizures and related EEG patterns on patient outcome, particularly in patients with sepsis, and to evaluate whether their prevention will improve outcomes. We are beginning some of these studies now.” SOURCE: Columbia University Medical Center
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