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Continuous electroencephalography in a surgical intensive care unit.

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Nonconvulsive seizures (NCSz) and periodic epileptiform discharges (PEDs) are common in surgical intensive care unit (SICU) patients. NCSz, particularly nonconvulsive status epilepticus (NCSE), are linked to poor outcomes, especially in septic patients.

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Area of Science:

  • Neurology
  • Critical Care Medicine
  • Neurophysiology

Background:

  • Altered mental status in surgical intensive care unit (SICU) patients often necessitates continuous electroencephalography (cEEG) monitoring.
  • Nonconvulsive seizures (NCSz), nonconvulsive status epilepticus (NCSE), and periodic epileptiform discharges (PEDs) are potential causes of altered mental status but are often undiagnosed without cEEG.

Purpose of the Study:

  • To determine the prevalence, risk factors, and impact on patient outcomes of NCSz, NCSE, and PEDs in SICU patients monitored with cEEG.
  • To identify associations between these EEG findings and poor hospital discharge outcomes.

Main Methods:

  • Retrospective analysis of 154 SICU patients with altered mental status undergoing cEEG monitoring over a 6-year period.
  • Assessment of the frequency of NCSz (including NCSE) and PEDs.
  • Multivariable logistic regression to evaluate the independent association of NCSz/NCSE and PEDs with poor outcomes (death, vegetative state, severe disability).

Main Results:

  • NCSz were detected in 16% of patients (5% with NCSE), and PEDs in 29%.
  • NCSE occurred exclusively in septic patients.
  • NCSz (including NCSE) were independently associated with poor outcomes (odds ratio 10.4, p=0.039).
  • Clinical seizures prior to cEEG were more common in patients with NCSz/NCSE.

Conclusions:

  • NCSz and PEDs are frequent findings in SICU patients with altered mental status requiring cEEG.
  • NCSz, including NCSE, are significantly associated with adverse hospital discharge outcomes in this population.
  • The presence of clinical seizures before cEEG monitoring may indicate a higher risk for NCSz.