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Pitfalls in ICU EEG Interpretation: A Retrospective Case Series
Aybuke Acar1, Brin E Freund1, William O Tatum1
1Department of Neurology, Mayo Clinic, Jacksonville, FL, USA.
The Neurohospitalist
|October 21, 2025
Summary
Interpreting electroencephalography (EEG) in the ICU is challenging due to artifacts mimicking seizures. Careful review of clinical context, EEG, and video is crucial for accurate diagnosis and optimal patient care.
Area of Science:
- Neurology
- Critical Care Medicine
- Neurophysiology
Background:
- Electroencephalography (EEG) use is expanding in intensive care units (ICUs) for seizure detection.
- The complex ICU environment and critically ill patients present unique interpretation challenges.
Purpose of the Study:
- To identify common pitfalls in ICU EEG interpretation.
- To provide strategies for differentiating epileptic seizures from non-epileptic mimics.
Main Methods:
- Retrospective case series design.
- Analysis of continuous video EEG (cvEEG) data from five ICU patients.
- Inclusion of patients with altered mental status, status epilepticus, or paroxysmal events.
Main Results:
- Physiological and device-related artifacts can mimic epileptic seizures.
- Plateau waves may resemble epileptic seizure deficits.
- Accurate differentiation requires integrating clinical context, EEG, and video data.
Conclusions:
- ICU EEG interpretation is complicated by artifacts and non-epileptic movements.
- A multidisciplinary approach and awareness of potential mimics improve diagnostic accuracy.
- Optimizing patient outcomes relies on precise cvEEG monitoring and interpretation.
Keywords:
electroencephalography < techniquesmovement disordersneurocritical care < clinical specialtyseizures < epilepsystatus epilepticus < epilepsyMore Related Videos
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