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Cortical surface intracranial electrodes identify clinically relevant seizures missed on scalp EEG after traumatic intracranial hemorrhage Volume 20, issue 6, December 2018

TEST YOURSELF

(1) Can TBI (and other critically ill) patients have seizures that are not visible on conventional scalp EEG?

(2) What are SIRPIDs?

(3) What methods for invasive EEG monitoring exist?

 

 

 

 

 

 

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Answers

(1) Yes, non-convulsive seizures have been identified in patients with traumatic brain injuries (and other severe illness) and, at times, are not visible on conventional scalp EEG. Since this may contribute to the patient’s alteration in consciousness, this may result in overly negative prognostication after TBI, and the metabolic demands of seizure may harm the primarily injured brain further.

(2) Stimulus-induced rhythmic, periodic, or ictal discharges (SIRPIDs) are defined as periodic, rhythmic, or ictal-appearing discharges that are consistently induced by alerting stimuli. They are commonly elicited by stimulation in critically ill, encephalopathic patients, and this stimulation (either intentionally or by means or nursing care) differentiates them from spontaneous seizures. Video correlation (or provocation) is often needed to make this diagnosis.

(3) Cortical grid, strip, and intraparenchymal “depth” microelectrode recordings are commonly used in elective surgical epilepsy monitoring. These devices are currently being evaluated for their utility in managing TBI patients at multiple institutions, and minimally invasive percutaneously placed intraparenchymal devices are also in development.

 

 

 

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