Ictal–interictal continuum: A proposed treatment algorithm. Issue 4 (April 2016)

• Record Type: Journal Article
• Authors: Rodríguez, Valia; Rodden, Meghan F.; LaRoche, Suzette M.
• Is Part Of: Clinical neurophysiology. Volume 127:Issue 4(2016:Apr.)
• Page Start: 2056
• Page End: 2064
• Publication Date: 2016-04
• Subjects: Ictal–interictal continuum -- Periodic discharges -- Rhythmic delta activity -- Continuous EEG monitoring -- ICU -- Critically ill patients -- Treatment algorithm; Neurophysiology -- Periodicals; Electroencephalography -- Periodicals; Electromyography -- Periodicals; Neurology -- Periodicals; 612.8
• DOI: 10.1016/j.clinph.2016.02.003
• Languages: English
• ISSNs: 1388-2457

Abstract

Highlights: Periodic and rhythmic EEG patterns that fall along the ictal–interictal continuum -IIC- are encountered frequently during continuous EEG monitoring in critically ill patients. There are clinical scenarios where the occurrence of an IIC pattern is highly suspicious for ictal activity and may contribute to secondary neuronal injury. A treatment algorithm is proposed based on actual IIC knowledge and best current practice in adults. Abstract: The ictal–interictal continuum (IIC) is characterized by periodic and/or rhythmic EEG patterns that occur with relative high frequency in critically ill patients. Several studies have reported that some patterns seen within the continuum are independently associated with poor outcome. However there is no consensus regarding when to treat them or how aggressive treatment should be. In this review we examine peer-reviewed original scientific articles, guidelines and reviews indexed in PubMed and summarize current knowledge related to the ictal–interictal continuum. A treatment algorithm to guide management of critically ill patients with EEG patterns that fall along the IIC is proposed. The algorithm-based on best current practice in adults-takes into account associated clinical events, risk factors for developing seizures, response to medication trials and biomarkers of neuronal injury.