Incidence of Electrographic Seizures in Pharmacologically Paralyzed Patients

Abstract

Objective: Pharmacologically paralyzed patients frequently undergo continuous EEG monitoring (cEEG) to assess for seizures. However, cEEG is costly, consumes valuable resources and there is limited data regarding seizure frequency in this population.Methods: Clinical and EEG data was collected from medical records for patients undergoing cEEG at Emory University between January 1, 2009 and August 31, 2011 and from an ICU EEG database between February 26, 2013 and July 2, 2014. Seizure incidence was compared between paralyzed and non-paralyzed patients. Neurological diagnosis, cEEG duration, medications and outcome were also assessed.Results: Three of the 103 (2.9%) paralyzed patients experienced seizures compared to 335/1955 (17.1%) that were non-paralyzed (p<0.001). Average duration of cEEG for patients receiving paralytics was 7.45 days vs. 2.38. Most patients in the first study period had a poor outcome (60/64, 93.8%). In the second study period, there were more sedatives used in the paralytic group (median 3 vs. 0). Conclusion:Seizures in pharmacologically paralyzed patients are uncommon and likely related to coadministered sedatives while cEEG duration is long and patient outcomes are poor.Significance: cEEG may be unnecessary in patients undergoing pharmacological paralysis and alternative means of monitoring sedation like Bispectral index may be more cost effective.