Similarity of Lateralized Rhythmic Delta Activity to Periodic Lateralized Epileptiform Discharges in Critically Ill Patients

Gaspard, Nicholas; Manganas, Louis; Rampal, Nishi; Petroff, Ognen A. C.; Hirsch, Lawrence J.

doi:10.1001/jamaneurol.2013.3475

Cited by 80 publications

(139 citation statements)

References 27 publications

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“…As rhythmic delta activity represented only a small proportion of the PP observed in our study, it is hard to draw firm conclusions regarding its association with IED. However, in a recent study, Gaspard et al [4] showed a strong association of lateralized rhythmic delta activity with lateralized periodic discharges and the occurrence of seizures.…”

Section: Discussionmentioning

confidence: 99%

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Electroencephalography Patterns and Prognosis in Acute Ischemic Stroke

et al. 2017

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Background and Purpose: The prognostic significance of interictal epileptiform discharges (IED) and periodic patterns (PP) after ischemic stroke has not been assessed. We sought to test whether IED and PP, detected on standard Electroencephalography (EEG) performed during the acute phase of ischemic stroke are associated with a worse functional outcome. Methods: One-hundred-fifty-seven patients 18 years or older with a diagnosis of acute ischemic stroke presenting within 72 h from stroke onset were prospectively enrolled and followed. Patients with a pre-stroke history of seizures or epilepsy, previous debilitating neurological disease or conditions that precluded the performance of EEG were excluded. Interpretation was performed by a blinded board certified neurophysiologist. IED and PP (grouped as epileptiform activity [EA]) were defined according to proposed guidelines. Univariable and multivariable analyses were used to identify predictors of outcome (modified Rankin Scale dichotomized ≤2 vs. ≥3) at 3 months. Results: In the univariable analysis, admission NIHSS (OR 1.20, 95% CI 1.12-1.28, p = 0.001), age (OR 1.03, 95% CI 1.01-1.05, p = 0.02), and presence of EA (OR 2.94, 95% CI 1.51-5.88, p = 0.001) were significantly associated with the outcome at 3 months. In the multivariable analysis, only admission NIHSS (OR 1.19, 95% CI 1.11-1.28, p < 0.001) and the presence of EA (OR 2.27, 95% CI 1.04-5.00, p = 0.04) were independently associated with the prognosis. Significance: The importance of EEG in the prognosis of acute ischemic stroke warrants additional research, examining the role of medication therapy on the outcome and the occurrence of seizures for those patients with specific EEG patterns.

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Section: Discussionmentioning

confidence: 99%

“…Their clinical and prognostic significance is largely unknown. Spikes, sharp waves, and periodic patterns (PP) such as periodic lateralized discharges and rhythmic delta have been linked to an increased risk of seizures in ischemic stroke [3,4,5]. …”

Section: Introductionmentioning

confidence: 99%

Electroencephalography Patterns and Prognosis in Acute Ischemic Stroke

et al. 2017

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“…The objectives of this project were to create a database (1) to serve as a repository of research data to facilitate multicenter studies and (2) to serve as a clinical tool that could be integrated into daily workflow for standardized reporting of cEEG monitoring results at member sites. Multicenter collaborative intensive care unit EEG collaboration is required to study relatively rare conditions and has resulted in key clinical findings in the field of cEEG (Gaspard et al, 2013a, 2013b; Kilbride et al, 2013; Schmitt et al, 2012). …”

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confidence: 99%

Development and Feasibility Testing of a Critical Care EEG Monitoring Database for Standardized Clinical Reporting and Multicenter Collaborative Research

Lee

LaRoche

Choi

et al. 2016

Journal of Clinical Neurophysiology

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Purpose The rapid expansion of the use of continuous critical care electroencephalogram (cEEG) monitoring and resulting multicenter research studies through the Critical Care EEG Monitoring Research Consortium has created the need for a collaborative data sharing mechanism and repository. The authors describe the development of a research database incorporating the American Clinical Neurophysiology Society standardized terminology for critical care EEG monitoring. The database includes flexible report generation tools that allow for daily clinical use. Methods Key clinical and research variables were incorporated into a Microsoft Access database. To assess its utility for multicenter research data collection, the authors performed a 21-center feasibility study in which each center entered data from 12 consecutive intensive care unit monitoring patients. To assess its utility as a clinical report generating tool, three large volume centers used it to generate daily clinical critical care EEG reports. Results A total of 280 subjects were enrolled in the multicenter feasibility study. The duration of recording (median, 25.5 hours) varied significantly between the centers. The incidence of seizure (17.6%), periodic/rhythmic discharges (35.7%), and interictal epileptiform discharges (11.8%) was similar to previous studies. The database was used as a clinical reporting tool by 3 centers that entered a total of 3,144 unique patients covering 6,665 recording days. Conclusions The Critical Care EEG Monitoring Research Consortium database has been successfully developed and implemented with a dual role as a collaborative research platform and a clinical reporting tool. It is now available for public download to be used as a clinical data repository and report generating tool.

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“…Substantial efforts have been made to standardize critical care EEG terminology and to associate EEG patterns with clinical course and outcome. [1][2][3][4][5] One of the main indications for CEEG is to detect electrographic seizures. Most electroencephalographers use a definition of seizures that includes a minimal duration of 10 seconds, [2][3][4][5][6][7] which reflects the typical duration of partial seizures in patients with chronic epilepsy.…”

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Brief Potentially Ictal Rhythmic Discharges in Critically Ill Adults

et al. 2014

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ontinuous electroencephalography (CEEG) monitoring is used increasingly to assess brain function in critically ill patients. Substantial efforts have been made to standardize critical care EEG terminology and to associate EEG patterns with clinical course and outcome. [1][2][3][4][5] One of the main indications for CEEG is to detect electrographic seizures. Most electroencephalographers use a definition of seizures that includes a minimal duration of 10 seconds, 2-7 which reflects the typical duration of partial seizures in patients with chronic epilepsy. [8][9][10] Rhythmic ictal-appearing patterns lasting less than 10 seconds have been described in neonates under different acronyms: brief rhythmic discharges (BRDs), brief electroencephalography rhythmic discharges (BERDs), and brief ictal rhythmic discharges (BIRDs). [11][12][13] In neonates, these patterns encompass discharges of any frequency, including less than 4 Hz, because they are common in this age group. Rhythmic delta activity and periodic discharges with a frequency of less than 4 Hz are common in critically ill patients but are usually not considered to be ictal. 3,5 Ictal discharges in children and adults often have a higher frequency than those in neonates. The occurrence of brief rhythmic discharges with a frequency higher than 4 Hz has never been studied in these older age groups.In this study, we sought to investigate the prevalence, significance, and prognostic implication of these discharges. In addition, we propose the acronym B(I)RDs (brief potentially ictal rhythmic discharges; the parentheses in the acronym indicate that their ictal nature is equivocal) in a group of critically ill patients. IMPORTANCE Brief potentially ictal rhythmic discharges, termed B(I)RDs, have been described mainly in neonates, and their significance in adults remains unclear.OBJECTIVE To describe the incidence of B(I)RDs in critically ill patients and investigate their association with seizures and outcome. DESIGN, SETTING, AND PARTICIPANTSWe reviewed the records of prospectively identified patients with B(I)RDs and patients serving as controls matched for age (±5 years) and primary diagnosis. MAIN OUTCOMES AND MEASURESThe prevalence of seizures during continuous electroencephalography and functional outcome, as measured by the Glasgow Outcome Scale, were determined. RESULTSWe identified B(I)RDs in 20 patients (2%). The pattern most often consisted of very brief (1-3 seconds) runs of sharply contoured theta activity without obvious evolution. All patients with B(I)RDs had cerebral injury, and in cases with a single focal lesion (11 [55%]), B(I)RDs were localized in the same region in all but 2 cases (18%). Patients with B(I)RDs were more likely to have seizures during continuous electroencephalography than were patients without B(I)RDs (15 of 20 [75%] vs 10 of 40 [25%]; P < .001), and 9 patients with B(I)RDs (60%) had only subclinical seizures. Brief potentially ictal rhythmic discharges were identified before seizures in all but 1 case (93%) and ceased in all 12 ...

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Similarity of Lateralized Rhythmic Delta Activity to Periodic Lateralized Epileptiform Discharges in Critically Ill Patients

Cited by 80 publications

References 27 publications

Electroencephalography Patterns and Prognosis in Acute Ischemic Stroke

Electroencephalography Patterns and Prognosis in Acute Ischemic Stroke

Development and Feasibility Testing of a Critical Care EEG Monitoring Database for Standardized Clinical Reporting and Multicenter Collaborative Research

Brief Potentially Ictal Rhythmic Discharges in Critically Ill Adults

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