Utility and Value of Movement Recording with Combined EEG-EMG Monitoring in the Intensive Care Unit

Continuous electroencephalographic (EEG) monitoring has become a standard of care in several contexts in the intensive care unit (ICU), especially for the management of refractory status epilepticus. ICU patients often present movement disorders that may be of epileptic or nonepileptic origin, and their correct identification is crucial for the diagnostic and therapeutic process. Video analysis is often insufficient to precisely detect or characterize movement disorders and the ICU environment is prone to many artifacts. Combined EEG electromyogram (EMG) monitoring can enhance the detection of epileptic seizures with subtle motor expression and help identify nonepileptic movement disorders, such as postanoxic myoclonus, dystonia, or tremor. We will review the various scenarios in which combined EEG-EMG monitoring is useful in routine ICU practice. We also provide a practical guide for easily placing surface EMG electrodes during continuous EEG recording, along with clinical examples to illustrate the significance of this combined approach.