Continuous EEG monitoring in the ICU

Abstract

Continuous EEG (cEEG) monitoring is one of many available techniques to assess cerebral function in critically ill patients. Detection and treatment of nonconvulsive seizures (NCSZ) and nonconvulsive status epilepticus (NCSE) are the main clinical applications of cEEG. These patterns are common and associated with poor outcome after severe brain injury. Quantitative EEG parameters can be used for early detection of NCSZ and ischemia caused by vasospasm after subarachnoid hemorrhage. Early and aggressive treatment of such complications may prevent secondary brain injury and avoid irreversible damage. Periodic epileptiform discharges (PEDs) are also seen frequently after acute brain injury and may be associated with poor outcome. However, to date, it is uncertain whether NCSZ, NCSE or PEDs cause additional injury or if they are epiphenomena of brain damage. Currently, there are many limitations to the widespread use of cEEG, particularly the lack of high quality studies. In the future, the role of cEEG as part of multimodality neuromonitoring should be further investigated to determine if optimization of neuronal activity, brain metabolism, oxygenation and perfusion profiles can prevent further damage to the brain and thereby improve outcome.