EEG monitoring in the intensive care unit

EEG recording in the intensive care setting presents a number of technical challenges. It is essential to differentiate artifact from pathophysiologic EEG changes that would suggest encephalopathy, epileptiform activity, or seizures. There are particular patterns typical of deepening encephalopathy, as well as, coma patterns that have diagnostic and prognostic significance (e.g., spindle coma, alpha coma, burst suppression activity, and triphasic waves). Epileptiform patterns, including periodic lateralized epileptiform discharges (PLEDs), bilateral independent periodic lateralized epileptiform discharges (BIPLEDs), and generalized periodic epileptiform discharges (GPEDs), present particular challenges as there is a gray-zone between interictal patterns and the evolving (usually faster) patterns of nonconvulsive seizures. Accurate use of EEG in the intensive care unit requires optimal EEG technical expertise in performing the study, and appropriate interpretation by a trained electrophysiologist.