Continuous Electroencephalography During and After Convulsive Status Epilepticus: Scope, Significance, and Standards

We report a case of super-refractory convulsive status epilepticus managed in our intensive care unit. Although the outcome was ultimately fatal, we present serial continuous electroencephalography (EEG) recordings obtained throughout this short but severe illness. Using this case as a framework, we explore the nuances and complexities of interpreting continuous EEG findings and related electrographic phenomena. In particular, we highlight the indications for continuous EEG monitoring based on validated instruments and examine the relationship between specific electrographic patterns and seizures or status epilepticus, including lateralized periodic discharges, lateralized rhythmic delta activity, generalized periodic discharges, and their modifiers. We also outline the evolving stages of status epilepticus as identified on continuous EEG, along with their therapeutic and prognostic implications. Finally, we demonstrate the role of continuous EEG in guiding therapeutic decision-making during status epilepticus, with particular emphasis on defining electrographic targets for anesthetic management.