Abstract

Introduction: Continuous electroencephalographic monitoring (cEEGm) is the main tool for diagnosis in subclinical seizures and non-convulsive status epilepticus (NCSE), in the intensive care units (ICU). Methods: We prospectively evaluated the cEEGm conducted between April 2012 and January 2013 in the adult and pediatric ICU. Results: We analyzed 38 cEEGm, corresponding to 36 patients (19 men). Mean age was 50 years (range: 5 months to 88 years). The most common indication for monitoring was impaired consciousness (53%), seconded by the presence of seizures observed by an ICU staff (42%). On average, monitoring lasted 85 hours (range: 4 to 479 hours). We found NCSE in 13 patients (34%) and subclinical seizures in 10 (26%). The mean duration of NCSE was 79 hours (range: 11 to 400 hours). Eight patients met criteria for super-refractory NCSE (62% of all NCES). The treatment of choice was anesthetics in 13 patients and the association of 3 antiepileptic drugs was commonly used (range: 0 to 10 drugs). In 79% of the patients, cEEGm motivated a change in the treatment plan. Overall mortality was 18%, and severe neurological sequelae were observed in 40% of patients. Conclusions: The cEEGm is a fundamental tool in the management of ICU patients; it allows accurate diagnosis of NCSE and subclinical epileptic activity, especially in patients with impaired consciousness and no clear evidence of seizures. These findings are associated with significant mortality and future neurologic sequelae.