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Plenary III: ICU Monitoring

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Program Length: 90 minutes
Non Credit

Overview

Continuous EEG (CEEG) is underutilized in encephalopathic,critically ill patients; thus, these patients either remain undiagnosed withnon-convulsive seizures, or are diagnosed later when the seizures are moredifficult to treat.  Neurologists shouldbe able to recognize the ictal and periodic patterns commonly seen incritically ill patients, and the large overlap in these patterns based on EEG alone.Some patterns are falsely considered definite seizures and others asdefinitively metabolic. We will review available evidence regarding these EEGpatterns and their significance (are they harmful?), including data from wellcontrolled animal studies and from invasive multimodality monitoring in humans.New official recommendations on when and how to perform CEEG will be presented.Discussions about the differences between current practice and expert consensuswill be reviewed, with attention to areas of controversy.

Learner Outcomes

  • Compare theEEG patterns seen in animal models of acute brain injury with those seen incritically ill patients, and evaluate evidence on whether these EEG patternsare associated with neuronal injury
  • IdentifyEEG patterns commonly encountered in ICU patients (ictal and periodic patterns)to enable rational treatment decisions for nonconvulsive status epilepticus
  • Describethe technical requirements for CEEG monitoring in the ICU to optimize utilityof CEEG monitoring
  • Evaluatethe evidence that identification and treatment of nonconvulsive seizuresimproves neurologic outcome. 

Target Audience

Neurologists, neuro-intensivists, electroencephalograpers,neurosurgeons and neurodiagnostic technologists

Program

Co-Chairs: Susan T. Herman, M.D. and Lawrence J. Hirsch,M.D.

Secondary Brain Injury from Nonconvulsive Seizures,Periodic Discharges and Other Depolarizations: Evidence from Animals and Humans
Jed Hartings, Ph.D.

Periodic Discharges and Other Controversial EEGPatterns
Nathan B. Fountain, M.D.

The New ICU EEG Monitoring Consensus Statement:Rationale and Implementation
Susan T. Herman, M.D.

CEEG: The Cutting Edge and Beyond
Lawrence J. Hirsch, M.D.