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Neurocritical care

Seizures after acute brain injury—more than meets the eye

Increasing use of brain monitoring via continuous EEG in intensive care units has revealed that subclinical seizures are common among adults and children with acute brain injury. Subclinical seizures are associated with worse outcomes, but whether their prompt detection and treatment improves outcomes remains a pressing clinical question.

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Figure 1: Schematic illustration of potential relationships between seizure burden and outcome.

References

  1. Claassen, J. et al. Recommendations on the use of EEG monitoring in critically ill patients: consensus statement from the neurointensive care section of the ESICM. Intensive Care Med. 39, 1337–1351 (2013).

    Article  CAS  Google Scholar 

  2. Claassen, J., Mayer, S. A., Kowalski, R. G., Emerson, R. G. & Hirsch, L. J. Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology 62, 1743–1748 (2004).

    Article  CAS  Google Scholar 

  3. Jette, N., Claassen, J., Emerson, R. G. & Hirsch, L. J. Frequency and predictors of nonconvulsive seizures during continuous electroencephalographic monitoring in critically ill children. Arch. Neurol. 63, 1750–1755 (2006).

    Article  Google Scholar 

  4. Abend, N. S. et al. Electrographic seizures in pediatric ICU patients: cohort study of risk factors and mortality. Neurology 23, 383–391 (2013).

    Article  Google Scholar 

  5. Arndt, D. H. et al. Subclinical early posttraumatic seizures detected by continuous EEG monitoring in a consecutive pediatric cohort. Epilepsia 54, 1780–1788 (2013).

    Article  Google Scholar 

  6. Vespa, P. M. et al. Nonconvulsive seizures after traumatic brain injury are associated with hippocampal atrophy. Neurology 75, 792–798 (2010).

    Article  CAS  Google Scholar 

  7. Vespa, P. M. et al. Nonconvulsive electrographic seizures after traumatic brain injury result in a delayed, prolonged increase in intracranial pressure and metabolic crisis. Crit. Care Med. 35, 2830–2836 (2007).

    Article  Google Scholar 

  8. Young, G. B., Jordan, K. G. & Doig, G. S. An assessment of nonconvulsive seizures in the intensive care unit using continuous EEG monitoring: an investigation of variables associated with mortality. Neurology 47, 83–89 (1996).

    Article  CAS  Google Scholar 

  9. Topjian, A. A. et al. Electrographic status epilepticus is associated with mortality and worse short-term outcome in critically ill children. Crit. Care Med. 41, 215–223 (2013).

    Article  Google Scholar 

  10. Husain, A. M. Treatment of Recurrent Electrographic Nonconvulsive Seizures (TRENdS) Study. Epilepsia 54 (Suppl. 6), 84–88 (2013).

    Article  CAS  Google Scholar 

Download references

Acknowledgements

C. D. Hahn has received grants from the Canadian Institutes of Health Research, The Hospital for Sick Children Foundation and the Physicians Services Incorporated Foundation. N. Jette holds a Population Health Investigator Award from Alberta Innovates Health Solutions and a Canada Research Chair Tier 2 in Neurological Health Services Research. She has received grants from the Canadian Institutes of Health Research, the Public Health Agency of Canada, Alberta Innovates Health Solutions, Alberta Health Services, the University of Calgary, the Hotchkiss Brain Institute, Alberta Health and Wellness, the American Epilepsy Society and the Milken Family Foundation.

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Correspondence to Nathalie Jette.

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Hahn, C., Jette, N. Seizures after acute brain injury—more than meets the eye. Nat Rev Neurol 9, 662–664 (2013). https://doi.org/10.1038/nrneurol.2013.231

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