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SPECT-negative SIRPIDs: less aggressive neurointensive care?
Christina C Smith1, William O Tatum, Vivek Gupta
1Departments of *Neurocritical Care Division and †Neurology, Mayo Clinic, Jacksonville, Florida, U.S.A.; ‡Department of Radiology, Division of Neuroradiology, Mayo Clinic, Jacksonville, Florida, U.S.A.; and §Department of Radiology, Division of Physics, Mayo Clinic, Jacksonville, Florida, U.S.A.
Summary
Single-photon emission computerized tomographic (SPECT) scans may help classify stimulus-induced rhythmic, periodic, or ictal discharges (SIRPIDs) in comatose patients. This can guide decisions to reduce aggressive anticonvulsant therapy when SIRPIDs are SPECT scan-negative.
Area of Science:
- Neurology
- Critical Care Medicine
- Radiology
Background:
- Management of EEG patterns in comatose ICU patients is understudied.
- Stimulus-induced rhythmic, periodic, or ictal discharges (SIRPIDs) classification is key for guiding anticonvulsant therapy.
- Hypothesized that SPECT imaging can differentiate ictal and interictal SIRPIDs.
Observation:
- Retrospective review of 235 ICU patients with EEGs and SPECT imaging over one year.
- Identified 2 patients with SIRPIDs who underwent SPECT imaging.
- Both patients demonstrated stimulation-provoked SIRPIDs on continuous EEG within 6-8 days of hospitalization.
Findings:
- SPECT imaging during SIRPIDs showed no significant hyperperfusion compared to scans without SIRPIDs.
- Absence of hyperperfusion on SPECT scans helped reduce aggressive anticonvulsant use.
- Subtracted SPECT imaging supported de-escalation of therapy.
Implications:
- SPECT-negative SIRPIDs may help supplement EEG interpretation.
- This approach can modify aggressive treatment strategies in comatose patients.
- Larger outcome-based studies are necessary to validate these findings.
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