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Ictal-Interictal Continuum: When to Worry About the Continuous Electroencephalography Pattern.

Justine Cormier¹, Carolina B Maciel^1,2, Emily J Gilmore^1,3

¹Department of Neurology, Yale University School of Medicine, New Haven, Connecticut.

Seminars in Respiratory and Critical Care Medicine

|December 21, 2017

Summary

This summary is machine-generated.

Continuous EEG monitoring aids critical care by detecting seizures, but also reveals patterns of unclear significance on the ictal-interictal continuum. Management guidelines are needed for these potentially harmful EEG findings.

Related Experiment Videos

Area of Science:

Neuroscience
Critical Care Medicine
Clinical Neurophysiology

Background:

Continuous electroencephalography (cEEG) monitoring is crucial for critically ill patients with encephalopathy and coma.
Increased use of cEEG has improved detection of nonconvulsive seizures (NCSz) and nonconvulsive status epilepticus (NCSE).
However, cEEG also identifies patterns with uncertain clinical significance, termed the ictal-interictal continuum (IIC).

Purpose of the Study:

To review IIC patterns, their clinical associations, seizure risk, and patient outcomes.
To propose a management strategy for IIC patterns in critical care.

Main Methods:

Literature review of IIC patterns and their clinical implications.
Synthesis of available data and expert opinion.

Main Results:

The ictal-interictal continuum (IIC) encompasses EEG patterns with varying clinical significance.
Some IIC patterns are associated with neuronal stress and secondary brain injury.
Current guidelines do not definitively address the management of these IIC patterns.

Conclusions:

The ictal-interictal continuum (IIC) presents a management challenge in critical care.
A structured clinical approach, based on available evidence and expert consensus, is proposed.
Further research is needed to clarify the significance and optimal management of IIC patterns.