Continuous EEG Monitoring: Principles and Practice PDF
Preview Continuous EEG Monitoring: Principles and Practice
Continuous EEG Monitoring Principles and Practice Aatif M. Husain Saurabh R. Sinha Editors 123 Continuous EEG Monitoring Aatif M. Husain • Saurabh R. Sinha Editors Continuous EEG Monitoring Principles and Practice Editors Aatif M. Husain Saurabh R. Sinha Neurology Neurology Duke University Medical Center Duke University Medical Center Durham Durham North Carolina North Carolina USA USA ISBN 978-3-319-31228-6 ISBN 978-3-319-31230-9 (eBook) DOI 10.1007/978-3-319-31230-9 Library of Congress Control Number: 2016959467 © Springer International Publishing Switzerland 2017 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG Switzerland The registered company is Gewerbestrasse 11, 6330 Cham, Switzerland To my late parents, Mairaj and Suraiya Husain. Every day I am reminded of their wisdom, humility, generosity and love. I hope I can pass on the lessons I learned from them to my children. Aatif M. Husain To my wife, Vandita, and children, Varun and Sneha. Their love and encouragement is a constant in an ever-changing and challenging world. Saurabh R. Sinha v Preface It was only 20 years ago that when continuous EEG (cEEG) monitoring was dis- cussed, it was in the context of monitoring patients in the epilepsy monitoring unit for spell characterization or epilepsy surgery evaluation. Certainly EEGs were per- formed in the intensive care units (ICU), and patients even underwent “prolonged monitoring.” However, in the era of paper EEGs, prolonged monitoring often con- sisted of turning the EEG machine on for 5 min every hour or so. Interpretation of reams of paper was done the following day. Partly because of what now appears to be rudimentary methods, we did not appreciate the extraordinary prevalence of sei- zures in critically ill patients. The last two decades have seen a remarkable change in our understanding of sei- zures in critically ill patients. Much of this change has been due to the availability of cEEG monitoring. The advent of digital EEG and advances in information technol- ogy have paved the way for the broad availability of cEEG monitoring, which has led to the realization that about 20 % of critically ill patients in whom cEEG monitoring is performed have seizures or status epilepticus (SE). The medical community has recognized the need for cEEG monitoring in large and small, university and com- munity hospitals, and this has fueled a remarkable demand for these services. Continuous EEG monitoring has now become a discipline in its own right. A few years ago, a handful of like-minded individuals set up the Critical Care EEG Monitoring and Research Consortium (CCEMRC); this consortium has grown to about 50 members. Many clinical neurophysiology fellowships have made cEEG monitoring education an essential part of their training. In fact, dedicated cEEG monitoring fellowships have also become available. Many clinical neurophysiolo- gists and neurointensivists now complete their training with a special interest and expertise in cEEG monitoring. Professional societies throughout the world have also started offering education and training in this discipline at their annual meet- ings. The American Board of Clinical Neurophysiology now offers a subspecialty certification in critical care EEG monitoring. This remarkable growth in cEEG monitoring was the impetus behind this book. The ever-expanding knowledge base, advances in recording and analysis, interpre- tation and treatment concerns, and implementation challenges can best be addressed in a textbook on this subject. In an effort to address these challenges and provide a state of the art of this field, we undertook editing Continuous EEG Monitoring: Principles and Practice. vii viii Preface With Continuous EEG Monitoring: Principles and Practice, we wanted to address all issues the practitioner may face in this field. With this in mind, we divided the text into four sections, “Clinical Aspects,” “Special Situations,” “Treatment,” and “Technical and Administrative Considerations.” Each chapter is written by authors who have been seminal to the advancement of cEEG monitoring. The “Clinical Aspects” section addresses the clinical issues of cEEG monitoring. Included are chapters detailing the history of the field, epidemiology of seizures and SE in critically ill patients, and classification of SE. Interpretative aspects of cEEG monitoring are also discussed in this section. Quantitative analysis of EEG is a vital aspect of this field, and several chapters are devoted to this. The “Special Situations” section addresses specific issues related to cEEG monitoring. Included are special situations that can lead to SE and warrant cEEG monitoring, such as anoxic enceph- alopathy, autoimmune SE, and medication-induced seizures. Critical care and prog- nostic issues in adults and children are also addressed in this section. The “Treatment” section has chapters detailing management options for acute seizure emergencies ranging from recurrent nonconvulsive seizures to super refractory SE. The final “Technical and Administrative Considerations” section deals with very important implementation issues for cEEG monitoring. The popularity of cEEG monitoring has not been without its challenges. EEG equipment, electrodes, staffing, billing, and information technology issues have all raised different challenges. These topics are addressed in this final section. The four sections of this book provide a comprehensive “principles and practice” approach to cEEG monitoring. Readers will find that they not only learn the scien- tific and clinical aspects of this field but are aware of the practical challenges and potential solutions. As such many different types of professionals will find value in this book. Neurology, clinical neurophysiology, epilepsy, and neurointensive care trainees will benefit from reading this book in its entirety. Practicing neurologists, particularly neurohospitalists and others involved with hospital inpatients, clinical neurophysiologists, intensivists, neurosurgeons, and neuroscientists, will also find many sections of value. Technologists will find a lot of useful information that will help them care for these patients. Administrators and managers will find material that will help them run their departments more efficiently. There are many individuals who have contributed to Continuous EEG Monitoring: Principles and Practice, and without them, this book would not have been possible. Foremost, we are extremely grateful to our colleagues who contributed chapters. They have spent many hours collating critical information to create this very useful textbook. Special thanks is due to the publisher, Springer Medicine Books, in par- ticular, Sylvana Freyberg who recognized the need for such a book and encouraged us to put it together and Sowmya Ramalingam who kept us on task to make sure this project reached culmination. The technologists, residents, fellows, neurologists, neurosurgeons, nurses, and administrators we work with at Duke University Medical Center must be recognized and thanked for their unwavering dedication to patients, education, research, and each other. Without them, we could not do any of what we do. Of course, the most important group of individuals who have contributed is our Preface ix patients. It is through their illness that we learn. It is this learning that we hope will provide more effective treatment for these and other patients. Finally, we must thank our families. Medicine is an extremely fulfilling and demanding profession. Our spouses and children endure our long work hours rou- tinely; this book added many more hours away from them. Without their constant support, encouragement, and motivation, none of this would have been possible. For that, and a lot more, we are forever grateful. Durham, NC, USA Aatif M. Husain Saurabh R. Sinha Contents Part I Clinical Aspects 1 The History of Continuous EEG Monitoring . . . . . . . . . . . . . . . . . . . . . . 3 Raoul Sutter and Peter W. Kaplan 2 Epidemiology of Seizures in Critically Ill Adults . . . . . . . . . . . . . . . . . . 13 Jennifer M. Pritchard and Jennifer L. Hopp 3 Epidemiology of Seizures in Critically Ill Children and Neonates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Nicholas S. Abend and Courtney J Wusthoff 4 Status Epilepticus Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 David Gloss 5 Criteria for Continuous EEG Monitoring . . . . . . . . . . . . . . . . . . . . . . . 59 Keith E. Dombrowski 6 P eriodic Complexes: Classification and Examples . . . . . . . . . . . . . . . . 67 Jessica W. Templer and Elizabeth E. Gerard 7 Electrographic Seizures in Adults: Recognition and Examples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Jonathan Halford 8 Electrographic Seizures in Pediatrics: Recognition and Examples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 Jessica L. Carpenter, N. Mehta, and T.N. Tsuchida 9 Patterns of Uncertain Significance . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Aneeta R. Saxena and Lawrence J. Hirsch 10 Artifacts Resembling Seizures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 Sarah Schmitt 11 Quantitative EEG Analysis: Basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 Saurabh R. Sinha xi xii Contents 12 QEEG in Seizure Detection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 Christa B. Swisher 13 Quantitative EEG in Neonatal Seizures . . . . . . . . . . . . . . . . . . . . . . . . 215 Juliet K. Knowles and Courtney J. Wusthoff 14 Quantitative EEG for Non-seizure Indications . . . . . . . . . . . . . . . . . . 231 Sahar Zafar and M. Brandon Westover 15 Q EEG Training Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257 Christa B. Swisher 16 N euroimaging in Status Epilepticus . . . . . . . . . . . . . . . . . . . . . . . . . . . 279 Ana M. Cartagena and G. Bryan Young Part II Special Situations 17 Acute Anoxic Injury and Therapeutic Hypothermia in Adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289 Amy Z. Crepeau 18 Autoimmune, Infectious, and Metabolic NCSE/NCS . . . . . . . . . . . . . 303 Abeer J. Hani and William B. Gallentine 19 Focal Neurologic Injury and Nonconvulsive Status Epilepticus/Nonconvulsive Seizures. . . . . . . . . . . . . . . . . . . . . . . . . . . . 319 Leslie A. Rudzinski and Elakkat D. Gireesh 20 Non-neurologic Causes of Nonconvulsive Status Epilepticus/Nonconvulsive Seizures. . . . . . . . . . . . . . . . . . . . . . . . . . . . 339 Yara Nazzal and Jennifer L. DeWolfe 21 Therapeutic Hypothermia in Children . . . . . . . . . . . . . . . . . . . . . . . . . 347 Laurence Ducharme-Crevier and Mark S. Wainwright 22 Medication-Induced Seizures and Status Epilepticus . . . . . . . . . . . . . 361 Deepti Zutshi 23 Super Refractory Status Epilepticus . . . . . . . . . . . . . . . . . . . . . . . . . . . 383 Joseph Zachariah, Jeff Britton, and Sara Hocker 24 Critical Care Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 417 Elie Dancour, Amy C. Jongeling, and Jan Claassen 25 Prognostication in Adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 445 Joao McONeil N.M. Plancher and Brandon Foreman 26 Prognostication in Pediatrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 465 Alejandra M. Stewart and Kevin E. Chapman
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