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Review
. 2025 Aug;43(1):333-344.
doi: 10.1007/s12028-025-02230-3. Epub 2025 Mar 3.

Utility and Value of Movement Recording with Combined EEG-EMG Monitoring in the Intensive Care Unit

Julie Lévi-Strauss  1 , Clémence Marois  2 , Yulia Worbe  3   4 , Laurine Bedoucha  2 , Raouf Benchikh Lehocine  5 , Benjamin Rohaut  2   4 , Nicolas Weiss  2   6   7 , Sophie Demeret  2 , Emmanuelle Apartis  3   4 , Virginie Lambrecq  4   5
Affiliations
Review

Utility and Value of Movement Recording with Combined EEG-EMG Monitoring in the Intensive Care Unit

Julie Lévi-Strauss et al. Neurocrit Care. 2025 Aug.

Abstract

Continuous electroencephalographic (EEG) monitoring has become a standard of care in several contexts in the intensive care unit (ICU), especially for the management of refractory status epilepticus. ICU patients often present movement disorders that may be of epileptic or nonepileptic origin, and their correct identification is crucial for the diagnostic and therapeutic process. Video analysis is often insufficient to precisely detect or characterize movement disorders and the ICU environment is prone to many artifacts. Combined EEG electromyogram (EMG) monitoring can enhance the detection of epileptic seizures with subtle motor expression and help identify nonepileptic movement disorders, such as postanoxic myoclonus, dystonia, or tremor. We will review the various scenarios in which combined EEG-EMG monitoring is useful in routine ICU practice. We also provide a practical guide for easily placing surface EMG electrodes during continuous EEG recording, along with clinical examples to illustrate the significance of this combined approach.

Keywords: Critical care; Electroencephalogram; Epilepsy; Hypoxia–ischemia; ICU; Movement disorders; Seizures.

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Conflict of interest statement

Declarations. Conflict of interest: NW has received consultant fees from Owkin and Alexion. CM has received consultant fees from UCB. The other authors declare no conflict of interest. Ethical Approval/Informed Consent: The present review has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. The patient gave written informed consent for the use of personal data. An information note was sent to each patient or to their relatives to confirm their nonopposition for the use of personal data. This study is registered in the “Assistance Publique—Hôpitaux de Paris” registry under the number 20240327134527.

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