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  • Title: Rhythmic and periodic EEG patterns of 'ictal-interictal uncertainty' in critically ill neurological patients.
    Author: Koren JP, Herta J, Pirker S, Fürbass F, Hartmann M, Kluge T, Baumgartner C.
    Journal: Clin Neurophysiol; 2016 Feb; 127(2):1176-1181. PubMed ID: 26679421.
    Abstract:
    OBJECTIVES: To study periodic and rhythmic EEG patterns classified according to Standardized Critical Care EEG Terminology (SCCET) of the American Clinical Neurophysiology Society and their relationship to electrographic seizures. METHODS: We classified 655 routine EEGs in 371 consecutive critically ill neurological patients into (1) normal EEGs or EEGs with non-specific abnormalities or interictal epileptiform discharges, (2) EEGs containing unequivocal ictal EEG patterns, and (3) EEGs showing rhythmic and periodic EEG patterns of 'ictal-interictal uncertainty' (RPPIIIU) according to SCCET. RESULTS: 313 patients (84.4%) showed normal EEGs, non-specific or interictal abnormalities, 14 patients (3.8%) had EEGs with at least one electrographic seizure, and 44 patients (11.8%) at least one EEG containing RPPIIIU, but no EEG with electrographic seizures. Electrographic seizures occurred in 11 of 55 patients (20%) with RPPIIIU, but only in 3 of 316 patients (0.9%) without RPPIIIU (p⩽0.001). Conversely, we observed RPPIIIU in 11 of 14 patients (78.6%) with electrographic seizures, but only in 44 of 357 patients (12.3%) without electrographic seizures (p⩽0.001). CONCLUSIONS: On routine-EEG in critically ill neurological patients RPPIIIU occur 3 times more frequently than electrographic seizures and are highly predictive for electrographic seizures. SIGNIFICANCE: RPPIIIU can serve as an indication for continuous EEG recordings.
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