You are here: MEDICA Portal. Our Topics in 2009. Topic of the Month September: Intensive Medicine. Neurology.
More Vigilant Monitoring Necessary
Using continuous EEG monitoring
researchers found that seizures
were common among patients in the
Medical ICU;© Wikipedia Commons
These subtle seizures may be affecting patients' prognoses and causing long-term brain damage, death and severe disability.
Both studies were led by Lawrence J. Hirsch, associate clinical professor of neurology, Columbia University Medical Center. His group, in conjunction with Drs. Stephan Mayer and Jan Claassen of the Neurological Intensive Care Unit (NICU) at NewYork-Presbyterian Hospital/Columbia, has previously shown that unrecognized seizures are common in the critically ill, particularly in those with acute brain injury, and that these seizures are associated with unfavorable outcomes.
The two studies found that electroencephalography was effective in detecting subtle seizures that are often impossible to detect by visual observation. Findings demonstrated the value of continuous EEG and intracranial EEG (ICE), an invasive technology where a probe is placed in the cortex of the patient's brain. ICE is mainly used in neurological intensive care units (ICU) for serious acute brain injuries, such as subarachnoid hemorrhage, severe head trauma and very large strokes (hemorrhagic or ischemic), which require other invasive brain monitoring devices.
"Monitoring for seizure activity in intensive care patients is important in order to identify small, clinically invisible seizures, which might explain why patients are not waking up – namely, because they are having lots of mini-seizures in multiple locations. Treating these clinically silent seizures may lead to improved alertness, reverse ongoing brain dysfunction, and prevent progressive injury to brain cells," says Dr. Hirsch. "Intracortical electroencephalography (ICE) appears to be the preferred method to monitor seizure activity in patients requiring other invasive brain monitoring, as it provides better, real-time brain monitoring, while patients in the Medical ICU should receive continuous EEG monitoring with standard, noninvasive electrodes."
MEDICA.de; Source: Columbia University Medical Center