Critical Care

Download Continuous EEG Monitoring: Principles and Practice by Aatif M. Husain, Saurabh R. Sinha PDF

By Aatif M. Husain, Saurabh R. Sinha

This booklet is designed to fulfill the necessity for a essentially orientated textbook at the speedily transforming into box of continuing EEG (cEEG) tracking. a variety of key medical facets are addressed, with clarification of prestige epilepticus category, standards for establishment of tracking, seizure styles and their reputation, quantitative EEG research, and neuroimaging in sufferers present process cEEG tracking. the worth of cEEG and the character of cEEG findings in numerous designated occasions are then reviewed, masking specific pathologies, serious care issues, and prognostication. remedies of nonconvulsive prestige epilepticus (NCSE) and nonconvulsive seizures (NCS) are mentioned. The concluding part is dedicated to special administrative concerns together with billing, staffing concerns, comparability of EEG machines, and knowledge know-how (IT) issues.Continuous EEG tracking bargains the single trustworthy technique of detecting seizures that aren't clinically seen in significantly ailing sufferers. Such seizures are universal: nearly 20% of sufferers present process cEEG tracking in sanatorium have NCSE or NCS. by contrast history, many hospitals have began to supply cEEG tracking as a foundation for supply of acceptable therapy. by way of offering the state-of-the-art in cEEG tracking, this booklet may be necessary to practitioners together with neurophysiologists, neurologists, neurointensivists, intensivists, neurophysiology and epilepsy fellows, and neurology citizens.

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However, the extent to which electrographic seizures are actually producing secondary brain injury versus serving as biomarkers of more severe acute brain injury remains unknown. Further, the extent to which seizures produce secondary brain injury is likely dependent on a complex interplay between acute brain injury etiology, seizure exposure, seizure characteristics, and seizure management strategies. As summarized below, a number of recent studies have reported an association between electrographic seizures, particularly with high electrographic seizure exposures, and worse outcomes even after adjustment for potential confounders related to acute encephalopathy etiology and critical illness severity.

Consistent with other single-center studies which demonstrated a high occurrence of EEG-only (also termed subclinical or nonconvulsive) seizures [3, 6, 8–10, 12, 14–16, 18], 35 % of children with electrographic seizures had exclusively EEG-only seizures [13]. Several studies have demonstrated that EEG-only seizures occur even in children who have not received any or recent paralytics [15, 18], indicating clinically evident changes were not being simply masked by paralytic administration, but that electromechanical uncoupling occurred, referring to a dissociation of electrical brain activity and outward mechanical signs.

Second, using these variables, the clinician could determine a model score. Third, patients with model scores above an institutional cutoff score would be selected to undergo cEEG monitoring. Individual institutions could select different model cutoff scores based on center-specific criteria. 10. At this lower cutoff, 14 % of patients with electrographic seizures would not undergo EEG monitoring, so the seizures would not be identified and managed. However, 58 % of patients without electrographic seizures would be identified as not needing EEG monitoring, so limited resources would not be expended.

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