Critically ill benign EEG variants: Is there such a thing?

Area of Science:

• Neuroscience
• Clinical Neurology
• Critical Care Medicine

Background:

• Critical care electroencephalography (ccEEG) is vital for detecting seizures in the ICU.
• Traditionally benign EEG variants (BEVs) are now frequently encountered in ICUs.
• The interpretation of BEVs in critically ill patients is challenging due to potential pathologic origins.

Purpose of the Study:

• To review the current literature on benign EEG variants (BEVs) in the intensive care unit (ICU).
• To assess the significance and potential pathologic sources of BEVs in critically ill patients.
• To provide guidance on interpreting BEVs in the ICU setting.

Main Methods:

• Extensive literature review of all known benign EEG variants (BEVs).
• Analysis of studies reporting BEVs in intensive care unit (ICU) populations.
• Synthesis of evidence regarding the origins and implications of BEVs in critical illness.

Main Results:

• BEV-like waveforms are increasingly recognized in the ICU and included in definitions of brief potentially ictal rhythmic discharges (BIRDs).
• The benign nature of BEVs in healthy outpatients does not directly translate to the ICU setting.
• Evidence suggests some BEVs may originate from pathological intracranial sources.

Conclusions:

• The significance of BEVs in the ICU remains largely unknown and requires careful interpretation.
• Certain BEVs in critically ill patients may not be benign and could indicate underlying pathology.
• Further research is needed to establish clear diagnostic criteria for BEVs in critical care.