Continuous EEG Monitoring

Transcription

1 Continuous EEG Monitoring

2 Aatif M. Husain Saurabh R. Sinha Editors Continuous EEG Monitoring Principles and Practice

3 Editors Aatif M. Husain Neurology Duke University Medical Center Durham North Carolina USA Saurabh R. Sinha Neurology Duke University Medical Center Durham North Carolina USA ISBN DOI / ISBN (ebook) Library of Congress Control Number: Springer International Publishing Switzerland 2017 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG Switzerland The registered company is Gewerbestrasse 11, 6330 Cham, Switzerland

4 To my late parents, Mairaj and Suraiya Husain. Every day I am reminded of their wisdom, humility, generosity and love. I hope I can pass on the lessons I learned from them to my children. Aatif M. Husain To my wife, Vandita, and children, Varun and Sneha. Their love and encouragement is a constant in an ever-changing and challenging world. Saurabh R. Sinha v

5 Preface It was only 20 years ago that when continuous EEG (ceeg) monitoring was discussed, it was in the context of monitoring patients in the epilepsy monitoring unit for spell characterization or epilepsy surgery evaluation. Certainly EEGs were performed in the intensive care units (ICU), and patients even underwent prolonged monitoring. However, in the era of paper EEGs, prolonged monitoring often consisted of turning the EEG machine on for 5 min every hour or so. Interpretation of reams of paper was done the following day. Partly because of what now appears to be rudimentary methods, we did not appreciate the extraordinary prevalence of seizures in critically ill patients. The last two decades have seen a remarkable change in our understanding of seizures in critically ill patients. Much of this change has been due to the availability of ceeg monitoring. The advent of digital EEG and advances in information technology have paved the way for the broad availability of ceeg monitoring, which has led to the realization that about 20 % of critically ill patients in whom ceeg monitoring is performed have seizures or status epilepticus (SE). The medical community has recognized the need for ceeg monitoring in large and small, university and community hospitals, and this has fueled a remarkable demand for these services. Continuous EEG monitoring has now become a discipline in its own right. A few years ago, a handful of like-minded individuals set up the Critical Care EEG Monitoring and Research Consortium (CCEMRC); this consortium has grown to about 50 members. Many clinical neurophysiology fellowships have made ceeg monitoring education an essential part of their training. In fact, dedicated ceeg monitoring fellowships have also become available. Many clinical neurophysiologists and neurointensivists now complete their training with a special interest and expertise in ceeg monitoring. Professional societies throughout the world have also started offering education and training in this discipline at their annual meetings. The American Board of Clinical Neurophysiology now offers a subspecialty certification in critical care EEG monitoring. This remarkable growth in ceeg monitoring was the impetus behind this book. The ever-expanding knowledge base, advances in recording and analysis, interpretation and treatment concerns, and implementation challenges can best be addressed in a textbook on this subject. In an effort to address these challenges and provide a state of the art of this field, we undertook editing Continuous EEG Monitoring: Principles and Practice. vii

6 viii Preface With Continuous EEG Monitoring: Principles and Practice, we wanted to address all issues the practitioner may face in this field. With this in mind, we divided the text into four sections, Clinical Aspects, Special Situations, Treatment, and Technical and Administrative Considerations. Each chapter is written by authors who have been seminal to the advancement of ceeg monitoring. The Clinical Aspects section addresses the clinical issues of ceeg monitoring. Included are chapters detailing the history of the field, epidemiology of seizures and SE in critically ill patients, and classification of SE. Interpretative aspects of ceeg monitoring are also discussed in this section. Quantitative analysis of EEG is a vital aspect of this field, and several chapters are devoted to this. The Special Situations section addresses specific issues related to ceeg monitoring. Included are special situations that can lead to SE and warrant ceeg monitoring, such as anoxic encephalopathy, autoimmune SE, and medication-induced seizures. Critical care and prognostic issues in adults and children are also addressed in this section. The Treatment section has chapters detailing management options for acute seizure emergencies ranging from recurrent nonconvulsive seizures to super refractory SE. The final Technical and Administrative Considerations section deals with very important implementation issues for ceeg monitoring. The popularity of ceeg monitoring has not been without its challenges. EEG equipment, electrodes, staffing, billing, and information technology issues have all raised different challenges. These topics are addressed in this final section. The four sections of this book provide a comprehensive principles and practice approach to ceeg monitoring. Readers will find that they not only learn the scientific and clinical aspects of this field but are aware of the practical challenges and potential solutions. As such many different types of professionals will find value in this book. Neurology, clinical neurophysiology, epilepsy, and neurointensive care trainees will benefit from reading this book in its entirety. Practicing neurologists, particularly neurohospitalists and others involved with hospital inpatients, clinical neurophysiologists, intensivists, neurosurgeons, and neuroscientists, will also find many sections of value. Technologists will find a lot of useful information that will help them care for these patients. Administrators and managers will find material that will help them run their departments more efficiently. There are many individuals who have contributed to Continuous EEG Monitoring: Principles and Practice, and without them, this book would not have been possible. Foremost, we are extremely grateful to our colleagues who contributed chapters. They have spent many hours collating critical information to create this very useful textbook. Special thanks is due to the publisher, Springer Medicine Books, in particular, Sylvana Freyberg who recognized the need for such a book and encouraged us to put it together and Sowmya Ramalingam who kept us on task to make sure this project reached culmination. The technologists, residents, fellows, neurologists, neurosurgeons, nurses, and administrators we work with at Duke University Medical Center must be recognized and thanked for their unwavering dedication to patients, education, research, and each other. Without them, we could not do any of what we do. Of course, the most important group of individuals who have contributed is our

7 Preface ix patients. It is through their illness that we learn. It is this learning that we hope will provide more effective treatment for these and other patients. Finally, we must thank our families. Medicine is an extremely fulfilling and demanding profession. Our spouses and children endure our long work hours routinely; this book added many more hours away from them. Without their constant support, encouragement, and motivation, none of this would have been possible. For that, and a lot more, we are forever grateful. Durham, NC, USA Aatif M. Husain Saurabh R. Sinha

8 Contents Part I Clinical Aspects 1 The History of Continuous EEG Monitoring Raoul Sutter and Peter W. Kaplan 2 Epidemiology of Seizures in Critically Ill Adults Jennifer M. Pritchard and Jennifer L. Hopp 3 Epidemiology of Seizures in Critically Ill Children and Neonates Nicholas S. Abend and Courtney J Wusthoff 4 Status Epilepticus Classification David Gloss 5 Criteria for Continuous EEG Monitoring Keith E. Dombrowski 6 Periodic Complexes: Classification and Examples Jessica W. Templer and Elizabeth E. Gerard 7 Electrographic Seizures in Adults: Recognition and Examples Jonathan Halford 8 Electrographic Seizures in Pediatrics: Recognition and Examples Jessica L. Carpenter, N. Mehta, and T.N. Tsuchida 9 Patterns of Uncertain Significance Aneeta R. Saxena and Lawrence J. Hirsch 10 Artifacts Resembling Seizures Sarah Schmitt 11 Quantitative EEG Analysis: Basics Saurabh R. Sinha xi

9 xii Contents 12 QEEG in Seizure Detection Christa B. Swisher 13 Quantitative EEG in Neonatal Seizures Juliet K. Knowles and Courtney J. Wusthoff 14 Quantitative EEG for Non-seizure Indications Sahar Zafar and M. Brandon Westover 15 QEEG Training Module Christa B. Swisher 16 Neuroimaging in Status Epilepticus Ana M. Cartagena and G. Bryan Young Part II Special Situations 17 Acute Anoxic Injury and Therapeutic Hypothermia in Adults Amy Z. Crepeau 18 Autoimmune, Infectious, and Metabolic NCSE/NCS Abeer J. Hani and William B. Gallentine 19 Focal Neurologic Injury and Nonconvulsive Status Epilepticus/Nonconvulsive Seizures Leslie A. Rudzinski and Elakkat D. Gireesh 20 Non-neurologic Causes of Nonconvulsive Status Epilepticus/Nonconvulsive Seizures Yara Nazzal and Jennifer L. DeWolfe 21 Therapeutic Hypothermia in Children Laurence Ducharme-Crevier and Mark S. Wainwright 22 Medication-Induced Seizures and Status Epilepticus Deepti Zutshi 23 Super Refractory Status Epilepticus Joseph Zachariah, Jeff Britton, and Sara Hocker 24 Critical Care Considerations Elie Dancour, Amy C. Jongeling, and Jan Claassen 25 Prognostication in Adults Joao McONeil N.M. Plancher and Brandon Foreman 26 Prognostication in Pediatrics Alejandra M. Stewart and Kevin E. Chapman

10 Contents xiii Part III Treatment 27 Treatment of Status Epilepticus with Nonsedating Antiepileptic Drugs Mariam Wasim and Aatif M. Husain 28 Treatment of Status Epilepticus with Anesthetic Drugs Nicolas Gaspard 29 Nonpharmacologic and Nontraditional Treatments for Status Epilepticus Elizabeth A. Felton and Mackenzie C. Cervenka 30 Treatment of Status Epilepticus in Pediatrics Arnold J. Sansevere and Tobias Loddenkemper 31 Investigational Treatments for Status Epileptics Asim Haque, Stephen A. VanHaerents, and Frank W. Drislane Part IV Technical and Administrative Considerations 32 EEG Equipment Saurabh R. Sinha 33 Electrodes and Montages Michael Pietak and Saurabh R. Sinha 34 Technical Considerations Crystal M. Keller 35 Staffing Considerations for ICU EEG Monitoring J. Andrew Ehrenberg, Andres Rodriguez, and Suzette M. Laroche 36 Coding and Billing Considerations Marc R. Nuwer 37 Reporting Results Tadeu A. Fantaneanu and Jong Woo Lee 38 Information Technology Issues Ronald G. Emerson Index

11 About the Editors Aatif M. Husain, MD is professor, Department of Neurology, Duke University Medical Center, and director, Neurodiagnostic Center, Veterans Affairs Medical Center, in Durham, North Carolina, USA. After completing medical school in Pakistan, he did an internship at the Henry Ford Hospital in Detroit, Michigan. He then completed a neurology residency at the Medical College of Pennsylvania in Philadelphia. After residency, Dr. Husain did fellowships in clinical neurophysiology, epilepsy and sleep medicine, and EMG/neuromuscular disorders at Duke University Medical Center. Since his fellowships, he has stayed at Duke University as faculty. He directs the clinical neurophysiology and sleep medicine fellowship programs at Duke University. His clinical interests include treatment of acute seizures and status epilepticus, neurophysiologic intraoperative monitoring, and general clinical neurophysiology. He has written many articles, chapters, and books on these topics. Dr. Husain is currently the editor in chief of the Journal of Clinical Neurophysiology and has been a past president of the American Clinical Neurophysiology Society and the American Board of Registration of EEG and EP Technologists. Saurabh R. Sinha, MD, PhD is associate professor and vice-chair for education, Department of Neurology, Duke University Medical Center, and director of the Epilepsy Monitoring Unit, Duke University Hospital. After receiving his B.Sc. in biomedical engineering from Johns Hopkins University in Baltimore, Maryland, he completed his M.D., Ph.D. (in neuroscience), and internship (internal medicine) at Baylor College of Medicine in Houston, Texas. Dr. Sinha completed his residency in neurology and fellowships in clinical neurophysiology and advanced epilepsy at Johns Hopkins Hospital. After 4 years as medical director of the Epilepsy Program at Sinai Hospital in Baltimore, Dr. Sinha joined Duke University Medical Center where he currently also serves as program director for the Neurology Residency. His clinical and research interests include surgical epilepsy, quantitative EEG analysis, and neurophysiologic intraoperative monitoring. Dr. Sinha is currently on the board of directors for the American Board of Registration of EEG and EP Technologists and the American Board of Clinical Neurophysiology and on the council of the American Clinical Neurophysiology Society. xv