Which EEG patterns deserve treatment in the ICU?

Abstract

Paroxysmal and periodic patterns on continuously recorded EEG are commonly seen in the neurocritical care setting. As these patterns span the nonepileptic, interictal, postictal, and ictal continuum, accurate identification and appropriate management may present major challenges. This chapter will survey the most commonly seen EEG features, including sharp waveforms, rhythmic waves, lateralized and generalized periodic discharges, and subclinical seizures. To date, evidence-based guidelines for the management of these patterns are lacking; reasonable approaches to their management will be presented. Where continuous EEG monitoring is available, a stepwise approach with close follow-up of these uncertain EEG features may be reasonable in a large number of these cases.