Continuous EEG Monitoring: Principles and Practice

660 Pages·2017·49.274 MB·English

by  Aatif M. Husain, Saurabh R. Sinha (eds.)

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
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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