Chronic Periodic Lateralized Epileptiform Discharges

Westmoreland, Barbara F.; Klass, Donald W.; Sharbrough, Frank W.

doi:10.1001/archneur.1986.00520050066024

Cited by 103 publications

(67 citation statements)

References 22 publications

(1 reference statement)

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“…One theory is that these patterns are surrogate markers for more severely injured brain (that could not be accounted for by multivariate analyses) and do not by themselves cause further brain injury. Rare cases of benign clinical courses with longstanding chronic PLEDs [8] or bilateral independent PLEDs [9] support this view. The alternative hypothesis is that PEDs and seizures in the acutely injured brain lead to secondary neuronal injury via excessive metabolic demand, excitotoxicity, or other mechanism.…”

Section: Commentsmentioning

confidence: 86%

How I Treat Patients with EEG Patterns on the Ictal–Interictal Continuum in the Neuro ICU

Claassen

2009

Neurocrit Care

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Refractory status epilepticus (RSE) is associated with a high risk of poor outcome and treated by most neurointensivists with continuous intravenous antiepileptic medications (cIV-AEDs). Continuous EEG monitoring has allowed us to unveil a number of epileptiform patterns of less certain significance. These have been labeled ictal to interictal continuum (IIC), many of which are associated with poor outcome. It is unclear to which extent individual patterns are epiphenomena or lead to additional brain injury. The treatment of these patterns is highly controversial and guidelines how to manage them are non existent. In this review of a challenging case, I will discuss a number of approaches to determine the ictal nature of the IIC in an effort to minimize neuronal injury from epileptiform brain activity on the one hand and from the treatment on the other hand. Ultimately it will be most important to replace the dichotomy of ictal versus non-ictal patterns by differentiating between harmful and non-harmful patterns.

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Section: Commentsmentioning

confidence: 86%

How I Treat Patients with EEG Patterns on the Ictal–Interictal Continuum in the Neuro ICU

Claassen

2009

Neurocrit Care

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“…Lateralized periodic discharges (LPD; previously periodic lateralized epileptiform discharges, PLEDs) can occur in a broad range of conditions, in which the patient is fully alert [47], such as focal cortical dysplasia, or presents with impaired consciousness [48][49][50][51][52][53][54][55][56][57], down to the level of coma (coma-LPDs) [14,58]. As with other EEG patterns, LPDs can be found in a variety of etiologies with cortical pathology (e.g., encephalitis, stroke, subarachnoidal bleeding, trauma, tumors, cysticercosis, and intoxication) [59] or subcortical pathology [60].…”

Section: Lateralized Periodic Dischargesmentioning

confidence: 99%

Which EEG patterns in coma are nonconvulsive status epilepticus?

Trinka¹,

Leitinger²

2015

Epilepsy & Behavior

139

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Nonconvulsive status epilepticus (NCSE) is common in patients with coma with a prevalence between 5% and 48%. Patients in deep coma may exhibit epileptiform EEG patterns, such as generalized periodic spikes, and there is an ongoing debate about the relationship of these patterns and NCSE. The purposes of this review are (i) to discuss the various EEG patterns found in coma, its fluctuations, and transitions and (ii) to propose modified criteria for NCSE in coma. Classical coma patterns such as diffuse polymorphic delta activity, spindle coma, alpha/theta coma, low output voltage, or burst suppression do not reflect NCSE. Any ictal patterns with a typical spatiotemporal evolution or epileptiform discharges faster than 2.5 Hz in a comatose patient reflect nonconvulsive seizures or NCSE and should be treated. Generalized periodic diacharges or lateralized periodic discharges (GPDs/LPDs) with a frequency of less than 2.5 Hz or rhythmic discharges (RDs) faster than 0.5 Hz are the borderland of NCSE in coma. In these cases, at least one of the additional criteria is needed to diagnose NCSE (a) subtle clinical ictal phenomena, (b) typical spatiotemporal evolution, or (c) response to antiepileptic drug treatment. There is currently no consensus about how long these patterns must be present to qualify for NCSE, and the distinction from nonconvulsive seizures in patients with critical illness or in comatose patients seems arbitrary. The Salzburg Consensus Criteria for NCSE [1] have been modified according to the Standardized Terminology of the American Clinical Neurophysiology Society [2] and validated in three different cohorts, with a sensitivity of 97.2%, a specificity of 95.9%, and a diagnostic accuracy of 96.3% in patients with clinical signs of NCSE. Their diagnostic utility in different cohorts with patients in deep coma has to be studied in the future. This article is part of a Special Issue entitled "Status Epilepticus".

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“…PLEDs tend to be transient and resolve spontaneously within 2 to 3 weeks, the discharges tend to decrease in amplitude, the repetition rate decreases and then the discharges cease 2,3,9,11,[26][27][28] . Chronic PLEDs, however, have been reported in patients with chronic epilepsy or old static lesions, especially related to recent seizures, alcohol withdrawal or chronic toxic-metabolic disturbances 4,7,9,11,14,15,26 .…”

Section: Periodic Lateralized Epileptiform Dischargespledsmentioning

confidence: 99%

“…Chronic PLEDs, however, have been reported in patients with chronic epilepsy or old static lesions, especially related to recent seizures, alcohol withdrawal or chronic toxic-metabolic disturbances 4,7,9,11,14,15,26 . The major controversy about PLEDs is whether they are ictal, interictal or a postictal phenomenon 2,3,9,15,23 .…”

Section: Periodic Lateralized Epileptiform Dischargespledsmentioning

confidence: 99%

Periodic EEG patterns: importance of their recognition and clinical significance

Andraus

Alves-Leon

2012

Arq. Neuro-Psiquiatr.

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Periodic electroencephalographic (EEG) patterns consist of discharges usually epileptiform in appearance, which occur at regular intervals, in critical patients. They are commonly classified as periodic lateralized epileptiform discharges (PLEDs), bilateral independent PLEDs or BIPLEDs, generalized epileptiform discharges (GPEDs) and triphasic waves. Stimulus-induced rhythmic, periodic or ictal discharges (SIRPIDs) are peculiar EEG patterns, which may be present as periodic discharges. The aim of this study is to make a review of the periodic EEG patterns, emphasizing the importance of their recognition and clinical significance. The clinical significance of the periodic EEG patterns is uncertain, it is related to a variety of etiologies, and many authors suggest that these patterns are unequivocally epileptogenic in some cases. Their recognition and classification are important to establish an accurate correlation between clinical, neurological, laboratorial and neuroimaging data with the EEG results.

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Chronic Periodic Lateralized Epileptiform Discharges

Cited by 103 publications

References 22 publications

How I Treat Patients with EEG Patterns on the Ictal–Interictal Continuum in the Neuro ICU

How I Treat Patients with EEG Patterns on the Ictal–Interictal Continuum in the Neuro ICU

Which EEG patterns in coma are nonconvulsive status epilepticus?

Periodic EEG patterns: importance of their recognition and clinical significance

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