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. 2024 May 27;14(11):1111.
doi: 10.3390/diagnostics14111111.

The Role of Routine Electroencephalography in the Diagnosis of Seizures in Medical Intensive Care Units

Cheng-Lun Hsiao  1   2 , Pei-Ya Chen  1   2 , I-An Chen  3 , Shinn-Kuang Lin  1   2
Affiliations

The Role of Routine Electroencephalography in the Diagnosis of Seizures in Medical Intensive Care Units

Cheng-Lun Hsiao et al. Diagnostics (Basel). .

Abstract

Seizures should be diagnosed and treated to ensure optimal health outcomes in critically ill patients admitted in the medical intensive care unit (MICU). Continuous electroencephalography is still infrequently used in the MICU. We investigated the effectiveness of routine EEG (rEEG) in detecting seizures in the MICU. A total of 560 patients admitted to the MICU between October 2018 and March 2023 and who underwent rEEG were reviewed. Seizure-related rEEG constituted 47% of all rEEG studies. Totally, 39% of the patients experienced clinical seizures during hospitalization; among them, 48% experienced the seizure, and 13% experienced their first seizure after undergoing an rEEG study. Seventy-seven percent of the patients had unfavorable short-term outcomes. Patients with cardiovascular diseases were the most likely to have the suppression/burst suppression (SBS) EEG pattern and the highest mortality rate. The rhythmic and periodic patterns (RPPs) and electrographic seizure (ESz) EEG pattern were associated with seizures within 24 h after rEEG, which was also related to unfavorable outcomes. Significant predictors of death were age > 59 years, the male gender, the presence of cardiovascular disease, a Glasgow Coma Scale score ≤ 5, and the SBS EEG pattern, with a predictive performance of 0.737 for death. rEEG can help identify patients at higher risk of seizures. We recommend repeated rEEG in patients with ESz or RPP EEG patterns to enable a more effective monitoring of seizure activities.

Keywords: critical illness; intensive care unit; routine electroencephalography; seizure; unfavorable outcome.

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Conflict of interest statement

The authors have no conflicts of interest to declare. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Five patterns of routine electroencephalography (displayed on bipolar montages). (A) Nonspecific slow waves, (B) suppression or burst suppression, (C) sporadic epileptiform discharges (arrowheads), (D) rhythmic and periodic patterns–lateralized sporadic discharges (arrows), and (E) electrographic seizures—3-Hz spike-and-wave complexes.
Figure 2
Figure 2
Spearman’s rank correlation coefficient plots revealing (A) strong inverse correlation between Glasgow Outcome Scale score and age and (B) strong positive correlation between Glasgow Outcome Scale score and Glasgow Coma Scale score.
Figure 3
Figure 3
A C-statistic of 0.737 is estimated for the prediction of death from a fit model of the five significant predictors obtained from the regression analysis in Table 5. AUC, area under the curve.
See this image and copyright information in PMC

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