Abstracts

Summary: Continuous EEG (CEEG) in the intensive care unit (ICU) is a new technology which offers the potential to continuously monitor brain function in critically ill patients, detect neurologic injuries and seizures at a reversible stage, and facilitate early treatment. The indications and technology for CEEG in the ICU are evolving, however, and there are no evidence-based guidelines for optimal use of this new procedure. In addition, there is little data to guide treatment of nonconvulsive seizures or nonconvulsive status epilepticus once these conditions have been diagnosed with CEEG. The absence of clear diagnosis and treatment guidelines has contributed to both underuse and misuse of CEEG in critically ill patients. This lecture will review new expert consensus recommendations for indications and performance of CEEG in the ICU. Most of the session will review monitoring for nonconvulsive seizures, but will also touch on monitoring for cerebral ischemia. The discussion will review available evidence on: 1) indications for CEEG - which patient populations should be monitored and for how long, and yield of CEEG for nonconvulsive seizures; 2) treatment options for nonconvulsive seizures and nonconvulsive status epilepticus and whether treatment affects neurologic outcome, and 3) technical and practical aspects of monitoring such as electrodes and montages, frequency of record review, and use of video. To assess how CEEG is being performed currently, adult and pediatric neurologists, epileptologists, and neurointensivists were surveyed regarding use of CEEG and treatment of nonconvulsive seizures. The differences between current practice and the expert consensus will be reviewed, highlighting areas of controversy.