Periodic Discharges: How to Approach, When to Treat

The use of continuous EEG monitoring has expanded in the last decade, allowing the recognition not only of nonconvulsive seizures but also of the relatively high prevalence of periodic and rhythmic EEG patterns. Periodic discharges are a fairly common EEG pattern and often present a therapeutic challenge when encountered. We will consider five associations of these periodic discharges: ictal, acute seizures, epileptogenic, injurious, and epiphenomenal. We present the challenges and unanswered questions pertaining to periodic discharges, along with several next steps and future directions to help enhance our understanding of periodic discharges. We also present an algorithmic approach to management centered on clinicoelectrographic and clinicoradiologic data.