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Clin Neurophysiol. 2015 Mar;126(3):463-71. doi: 10.1016/j.clinph.2014.05.037. Epub 2014 Jul 11.

The probability of seizures during EEG monitoring in critically ill adults.

Author information

1
Department of Neurology, Epilepsy Service, Massachusetts General Hospital, Wang 720, Boston, MA 02114, USA. Electronic address: mwestover@mgh.harvard.edu.
2
Department of Neurology, Epilepsy Service, Massachusetts General Hospital, Wang 720, Boston, MA 02114, USA; Department of Neurology, Epilepsy Service, Beth Israel Deaconess Medical Center, West/Baker 5, Boston, MA 02214, USA. Electronic address: mshafi@bidmc.harvard.edu.
3
Department of Neurology, Epilepsy Service, Massachusetts General Hospital, Wang 720, Boston, MA 02114, USA. Electronic address: mtbianchi@mgh.harvard.edu.
4
Department of Neurology, Epilepsy Service, Massachusetts General Hospital, Wang 720, Boston, MA 02114, USA. Electronic address: lmoura@mgh.harvard.edu.
5
Department of Neurology, Epilepsy Service, Massachusetts General Hospital, Wang 720, Boston, MA 02114, USA. Electronic address: daorourke@mgh.harvard.edu.
6
Department of Neurology, Epilepsy Service, Massachusetts General Hospital, Wang 720, Boston, MA 02114, USA. Electronic address: erosenthal@mgh.harvard.edu.
7
Department of Neurology, Epilepsy Service, Massachusetts General Hospital, Wang 720, Boston, MA 02114, USA. Electronic address: cchu3@mgh.harvard.edu.
8
Department of Neurology, Epilepsy Service, Massachusetts General Hospital, Wang 720, Boston, MA 02114, USA.
9
Department of Neurology, Epilepsy Service, Massachusetts General Hospital, Wang 720, Boston, MA 02114, USA. Electronic address: dbhoch@mgh.harvard.edu.
10
Department of Neurology, Epilepsy Service, Massachusetts General Hospital, Wang 720, Boston, MA 02114, USA. Electronic address: rkilbride@mgh.harvard.edu.
11
Department of Neurology, Epilepsy Service, Massachusetts General Hospital, Wang 720, Boston, MA 02114, USA. Electronic address: acole1@mgh.harvard.edu.
12
Department of Neurology, Epilepsy Service, Massachusetts General Hospital, Wang 720, Boston, MA 02114, USA. Electronic address: scash@mgh.harvard.edu.

Abstract

OBJECTIVE:

To characterize the risk for seizures over time in relation to EEG findings in hospitalized adults undergoing continuous EEG monitoring (cEEG).

METHODS:

Retrospective analysis of cEEG data and medical records from 625 consecutive adult inpatients monitored at a tertiary medical center. Using survival analysis methods, we estimated the time-dependent probability that a seizure will occur within the next 72-h, if no seizure has occurred yet, as a function of EEG abnormalities detected so far.

RESULTS:

Seizures occurred in 27% (168/625). The first seizure occurred early (<30min of monitoring) in 58% (98/168). In 527 patients without early seizures, 159 (30%) had early epileptiform abnormalities, versus 368 (70%) without. Seizures were eventually detected in 25% of patients with early epileptiform discharges, versus 8% without early discharges. The 72-h risk of seizures declined below 5% if no epileptiform abnormalities were present in the first two hours, whereas 16h of monitoring were required when epileptiform discharges were present. 20% (74/388) of patients without early epileptiform abnormalities later developed them; 23% (17/74) of these ultimately had seizures. Only 4% (12/294) experienced a seizure without preceding epileptiform abnormalities.

CONCLUSIONS:

Seizure risk in acute neurological illness decays rapidly, at a rate dependent on abnormalities detected early during monitoring. This study demonstrates that substantial risk stratification is possible based on early EEG abnormalities.

SIGNIFICANCE:

These findings have implications for patient-specific determination of the required duration of cEEG monitoring in hospitalized patients.

KEYWORDS:

Continuous electroencephalography; ICU EEG monitoring; Nonconvulsive seizures

PMID:
25082090
PMCID:
PMC4289643
DOI:
10.1016/j.clinph.2014.05.037
[Indexed for MEDLINE]
Free PMC Article
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