Use of EEG monitoring and management of non-convulsive seizures in critically Ill patients: A survey of neurologists

Document Type

Article

Abstract

Background Continuous EEG monitoring (cEEG) of critically ill patients is frequently utilized to detect nonconvulsive seizures (NCS) and status epilepticus (NCSE). The indications for cEEG, as well as when and how to treat NCS, remain unclear. We aimed to describe the current practice of cEEG in critically ill patients to define areas of uncertainty that could aid in designing future research. Methods Weconducted an international survey of neurologists focused on cEEG utilization and NCS management. Results Three-hundred and thirty physicians completed the survey. 83% use cEEG at least once per month and 86% manage NCS at least five times per year. The use of cEEG in patients with altered mental status was common (69%), with higher use if the patient had a prior convulsion (89%) or abnormal eye movements (85%). Most respondents would continue cEEG for 24 h. If NCS or NCSE is identified, the most common anticonvulsants administered were phenytoin/fosphenytoin, lorazepam, or levetiracetam, with slightly more use of levetiracetam for NCS than NCSE. Conclusions Continuous EEG monitoring (cEEG) is commonly employed in critically ill patients to detect NCS and NCSE. However, there is substantial variability in current practice related to cEEG indications and duration and to management of NCS and NCSE. The fact that such variability exists in the management of this common clinical problem suggests that further prospective study is needed. Multiple points of uncertainty are identified that require investigation.© Springer Science+Business Media, LLC 2010.

Publication Date

6-1-2010

Publication Title

Neurocritical Care

ISSN

15416933

Volume

12

Issue

3

First Page

382

Last Page

389

PubMed ID

20198513

Digital Object Identifier (DOI)

10.1007/s12028-010-9337-2

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