EEG and Status Eplilepticus by Tania Farrar
Tania is a neurologist and epileptologist with expertise in continuous EEG (cEEG) and status epilepticus (SE). This talk covers what a seizure is, what status is, including focal and generalised status epilepticus. So why do we do cEEGs for patients with suspected SE? To confirm the diagnosis To see if patient just post ictal or still seizing To establish that the clinical and electric seizures have stopped To see if burst suppression is achieved To exclude other differential diagnoses She makes a good argument for why cEEG is such an important tool in managing SE. In the questions after the talk, the issue of availability of cEEG in the Australian setting was discussed. Limited montage EEGs are discussed including their pros and cons.
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EEG and Status Eplilepticus by Tania Farrar
- 2. EEG in Status Epilepticus By Tania Farrar
- 3. Topics What is status epilepticus (SE) Why do we need cEEG in SE
- 4. What is Status Epilepticus? A seizure is a paroxysmal electrical discharge of neurons in the brain resulting in a change of function or behaviour. Excessive excitation and/or inadequate inhibition results in status epilepticus. SE can have long-term consequences depending on the type and duration of seizures.
- 5. What is Status Epilepticus? Clinically someone is in SE if they have a GTCS >5 minutes or multiple shorter seizures without complete recovery to baseline in between. GTCS lasting >30 minutes carry a risk of long term consequences due to neuronal injury/death. For focal SE and absence SE the duration of time to injury is unknown.
- 6. What is Status Epilepticus? A definition and classification of status epilepticus – Report of the ILAE Task Force on Classification of Status Epilepticus. 2015
- 7. Why do we need cEEG in SE? 1. Confirmation of SE 2. Establish cessation of electrical seizure activity 3. Confirm burst suppression 4. Ensure we are treating seizures
- 8. Confirmation of SE Are there ongoing Sz or are they post-ictal? Exclusion of other pathologies • PNES • Movement disorders • Drug reactions • Encephalopathies
- 9. Establish cessation of electrical seizure activity Just because the physical seizure activity has stopped does not mean the brain is ‘quiet’
- 16. Establish cessation of electrical seizure activity So the muscle artefact there shows that was a clinical seizure but what about this next one?
- 27. Why do we need cEEG in SE? 1. Confirmation of SE 2. Establish cessation of electrical seizure activity 3. Confirm burst suppression 4. Ensure we are treating seizures
- 28. Burst suppression • In RSE anaesthetics are used to induce burst suppression to try to ‘break’ the seizure cycle. • The ratio of burst to suppression is ~1:10 • This ratio is LESS important than the nature of the burst
- 29. UGLY burst
- 30. PRETTY burst
- 31. Ensure we are treating seizures 1. This includes both under and over treatment of clinical activity 2. Under treating is dangers but so is over treating 3. Over treating can prolong sedation and intubation.
- 32. Summary 1. SE is both a clinical and neurophysiological diagnosis. 2. cEEG is important for managing SE as it ensures we adequately treat electrical Sz activity without over treating the patient.
- 33. cEEG in Status Epilepticus
Editor's Notes
- including neuronal death, neuronal injury, and alteration of neuronal networks, depending on the type and duration of seizures.
- Exclusion of other diagnosis – PNES and movement disorders/drug reactions