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  • Title: Stimulus-induced generalized epileptiform discharges: an unrecognized EEG pattern in refractory nonconvulsive status epilepticus.
    Author: Gaig C, Iranzo A, Tercero A, Herman ST, Santamaria J.
    Journal: J Clin Neurophysiol; 2014 Dec; 31(6):580-5. PubMed ID: 25462146.
    Abstract:
    PURPOSE: To report an unrecognized EEG pattern occurring in patients with coma with nonconvulsive status epilepticus (NCSE) treated with thiopental and characterized by a high amplitude generalized sharp wave that was induced by isolated or repetitive low frequency photic or tactile stimulation (stimulus-induced generalized epileptiform discharges). METHODS: Review of clinical and EEG records of 4 patients with stimulus-induced generalized epileptiform discharges identified among patients admitted to an intensive care unit (ICU) of our institution who underwent EEG monitoring between July 2011 and January 2013. RESULTS: Four patients had refractory NCSE secondary to hepatic encephalopathy, brain tumor, immunomediated encephalopathy, or anti-NMDA encephalitis. All of them were treated with several antiepileptic drugs and anesthetics, but stimulus-induced generalized epileptiform discharges were only recorded after control of NCSE with thiopental. The discharges occurred without associated clinical manifestations. Two patients died in the ICU, and two had a favorable outcome. Stimulus-induced generalized epileptiform discharges were not recorded in 240 critically ill patients admitted to the ICU who had an EEG recorded during this period. Twenty-two of them were in NCSE, and only one was treated with thiopental. CONCLUSIONS: Stimulus-induced generalized epileptiform discharges is an EEG pattern occurring in patients with NCSE treated with thiopental. The clinical relevance and pathophysiology of stimulus-induced generalized epileptiform discharges remain to be clarified.
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