Time ‐dependent risk of seizures in critically ill patients on continuous electroencephalogram

ObjectiveFind the optimal continuous electroencephalographic (CEEG) monitoring duration for seizure detection in critically ill patients.
MethodsWe analyzed prospective data from 665 consecutive CEEGs, including clinical factors and time‐to‐event emergence of electroencephalographic (EEG) findings over 72 hours. Clinical factors were selected using logistic regression. EEG risk factors were selected a priori. Clinical factors were used for baseline (pre‐EEG) risk. EEG findings were used for the creation of a multistate survival model with 3 states (entry, EEG risk, and seizure). EEG risk state is defined by emergence of epileptiform patterns.
ResultsThe clinical variables of greatest predictive value were coma (31% had seizures; odds ratio [OR] = 1.8, p < 0.01) and history of seizures, either remotely or related to acute illness (34% had seizures; OR = 3.0, p < 0.001). If there were no epileptiform findings on EEG, the risk of seizures within 72 hours was between 9% (no clinical risk factors) and 36% (coma and history of seizures). If epileptiform findings developed, the seizure incidence was between 18% (no clinical risk factors) and 64% (coma and history of seizures). In the absence of epileptiform EEG abnormalities, the duration of monitoring needed for seizure risk of <5% was between 0.4 hours (for patients who are not comatose and had no prior seizure) and 16.4 hours (comatose and prior seizure).
InterpretationThe initial risk of seizures o...

Source: Annals of Neurology - July 19, 2017 Category: Neurology Authors: Aaron F. Struck, Gamaleldin Osman, Nishi Rampal, Siddhartha Biswal, Benjamin Legros, Lawrence J. Hirsch, M. Brandon Westover, Nicolas Gaspard Tags: Research Article Source Type: research