Ictal Interictal Continuum Patterns

Osman, Gamaleldin; Araújo, Davi Farias de; Maciel, Carolina B.

doi:10.1007/s11940-018-0500-y

Cited by 15 publications

(11 citation statements)

References 76 publications

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“…Metabolic modifications induced by neuronal discharges result in increased neuronal oxygen and metabolite needs, cerebral blood flow (CBF), intracranial pressure (Vespa et al, 2007;Witsch et al, 2017) and intracerebral lactate/pyruvate ratio (LPR) (Marcoux et al, 2008), a phenomenon coined by some authors as ''metabolic crisis" (Ko, 2013;Claassen et al, 2014;De Marchis et al, 2016;Vespa et al, 2016). In intensive care settings, PDs are also associated with poorer outcomes (Foreman et al, 2012;Osman et al, 2018). All those mechanisms could potentially contribute to ND in IS.…”

Section: Introductionmentioning

confidence: 99%

Epileptic activity in neurological deterioration after ischemic stroke, a continuous EEG study

Scoppettuolo

Gaspard

Depondt

et al. 2019

Clinical Neurophysiology

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h i g h l i g h t s Epileptic activities (EA) are found in 44% of acute stroke neurological deterioration. Ictal patterns and Periodic discharges (PDs) responds to anti-epileptic drugs. Treating ictal patterns and PDs could prevent adverse metabolic consequences of EA. a b s t r a c t Objective: Despite improvement in acute stroke care, almost 40% of patients with ischemic stroke present neurological deterioration. Neurological deterioration is associated with higher death and dependency rates. Neurological deterioration mechanisms are unknown, and half of neurological deterioration remains unexplained. We postulate that a substantial proportion of neurological deterioration in ischemic stroke is associated with periodic discharges/non-convulsive seizures that negatively impact the recovery of ischemic stroke and worsen symptoms. Methods: Retrospective review of 24 h continuous EEG monitoring (cEEG) performed for neurological deterioration in the stroke unit of a tertiary academic centre. Results: Eighty-one patients were included. cEEG detected epileptic activities in 44% of cases (Nonconvulsive seizures/non-convulsive status epilepticus: 10/81 (12%), periodic discharges: 17/81 (21%) and sporadic epileptiform discharges in 14/81 (17%)). The proportion of patients who did not receive recanalization therapy was significantly higher in the NCSE/NCSz/PDs group than in the group devoid of NCSE/NCSz/PDs: 17/22 (77%) vs 13/59 (22%); p < 0,001. Treatment of Non-convulsive seizures /nonconvulsive status epilepticus and periodic discharges was followed by EEG improvement in respectively 7/8 and 10/16 of treated patients. Conclusions: Non-convulsive seizures /non-convulsive status epilepticus /periodic discharges are associated to neurological deterioration after ischemic stroke. Significance: Treatment of Non-convulsive seizures /non-convulsive status epilepticus and periodic discharges, if such patterns are detected, could help prevent adverse metabolic consequences of epileptic activities on ischemic brain tissue.

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Section: Introductionmentioning

confidence: 99%

Epileptic activity in neurological deterioration after ischemic stroke, a continuous EEG study

Scoppettuolo

Gaspard

Depondt

et al. 2019

Clinical Neurophysiology

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“…The increased risk of seizures associated with IIC patterns has been well-described. Morphology, duration and frequency of IIC patterns are highly predictive of the seizure risk [51]. Overall, the incidence of seizures in critically ill patients range from 45 to 95% in patients with LPDs (Fig.…”

Section: Risk Of Electrographic Seizures Associated With Iicmentioning

confidence: 99%

“…In generally, GRDA lies at the interictal end of IIC spectrum, whereas LPDs lay at the ictal end of IIC spectrum. Patterns including GPDs, LRDA and B(I) RDs are in the middle range of IIC spectrum for the seizure risk [51,53]. IIC patterns with frequencies > 1.5 Hz were associated with an increased seizure risk [22].…”

Section: Risk Of Electrographic Seizures Associated With Iicmentioning

confidence: 99%

“…There are no evidence-based guidelines on how to treat patients with IIC patterns, particularly on how aggressively to treat. A number of treatment algorithms have been proposed in the literature, which can be summarized in several different approaches [9,51,53,[71][72][73][74]. Treatment decision should be guided by the previously discussed risk stratification on a case by case basis.…”

Section: Treatment Algorithmsmentioning

confidence: 99%

“…It is critical that patients with IIC patterns should be monitored with continuous EEG for the surveillance of NCS and NCSE. Prophylactic treatment with non-sedating anti-seizure medications (ASM) such as Levetiracetam and Lacosamide may be considered [51]. The therapeutic goal of prophylaxis is to prevent IIC patterns from evolving into seizures as seen in Fig.…”

Section: Mitigate the Seizure Risk Associated With Iic Patternsmentioning

confidence: 99%

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Ictal-interictal continuum: a review of recent advancements

Tao

Qin

Wang

2020

Acta Epileptologica

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Continuous electroencephalogram (cEEG) has become an indispensable technique in the management of critically ill patients for early detection and treatment of non-convulsive seizures (NCS) and non-convulsive status epilepticus (NCSE). It has also brought about a renaissance in a wide range of rhythmic and periodic patterns with heterogeneous frequency and morphology. These patterns share the rhythmic and sharp appearances of electrographic seizures, but often lack the necessary frequency, spatiotemporal evolution and clinical accompaniments to meet the definitive criteria for ictal patterns. They may be associated with cerebral metabolic crisis and neuronal injury, therefore not clearly interictal either, but lie along an intervening spectrum referred to as ictal-interictal continuum (IIC). Generally speaking, rhythmic and periodic patterns are categorized as interictal patterns when occurring at a rate of <1Hz, and are categorized as NCS and NCSE when occurring at a rate of >2.5 Hz with spatiotemporal evolution. As such, IIC commonly includes the rhythmic and periodic patterns occurring at a rate of 1-2.5 Hz without spatiotemporal evolution and clinical correlates. Currently there are no evidence-based guidelines on when and if to treat patients with IIC patterns, and particularly how aggressively to treat, presenting a challenging electrophysiological and clinical conundrum. In practice, a diagnostic trial with preferably a non-sedative anti-seizure medication (ASM) can be considered with the end point being both clinical and electrographic improvement. When available and necessary, correlation of IIC with biomarkers of neuronal injury, such as neuronal specific enolase (NSE), neuroimaging, depth electrode recording, cerebral microdialysis and oxygen measurement, can be assessed for the consideration of ASM treatment. Here we review the recent advancements in their clinical significance, risk stratification and treatment algorithm.

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Common Abnormal EEG in Neurocritical Ill Patients

Wang

et al. 2021

Multi-Modal EEG Monitoring of Severely Neurologically Ill Patients

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Ictal Interictal Continuum Patterns

Cited by 15 publications

References 76 publications

Epileptic activity in neurological deterioration after ischemic stroke, a continuous EEG study

Epileptic activity in neurological deterioration after ischemic stroke, a continuous EEG study

Ictal-interictal continuum: a review of recent advancements

Common Abnormal EEG in Neurocritical Ill Patients

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