Department of Neurology, Yale University School of Medicine, New Haven, Connecticut.
Department of Neurology, UF Health Shands Hospital, University of Florida College of Medicine, Gainesville, Florida.
Semin Respir Crit Care Med. 2017 Dec;38(6):793-806. doi: 10.1055/s-0037-1607987. Epub 2017 Dec 20.
Continuous electroencephalography (cEEG) monitoring is an invaluable tool in the evaluation of encephalopathy and coma in critically ill patients. Marked increases in cEEG monitoring, coinciding with several societal guideline statements in the last decade, have allowed earlier detection and treatment of clearly harmful patterns, including nonconvulsive seizures (NCSz) and nonconvulsive status epilepticus (NCSE). However, it has also unmasked a range of EEG patterns of less clear clinical significance, with some more "malignant" than others given their potential association with increased neuronal stress and secondary brain injury. These patterns lay on a spectrum often referred to as the ictal-interictal continuum (IIC). To date, no definitive guidelines exist for the management of these potentially harmful EEG patterns, thus presenting a clinical dilemma for critical care physicians. Here, we review the various IIC patterns, their associated features, seizure risk, and outcomes and also propose a clinical approach to management based on the available data and expert opinion.
连续脑电图（cEEG）监测在评估危重病患者的脑病和昏迷方面是一种非常有价值的工具。过去十年中，随着社会指南的几项声明，cEEG 监测的使用显著增加，这使得更早期地发现和治疗明显有害的模式成为可能，包括非惊厥性发作（NCSz）和非惊厥性癫痫持续状态（NCSE）。然而，它也揭示了一系列临床意义不太明确的脑电图模式，其中一些比其他模式更“恶性”，因为它们可能与神经元应激增加和继发性脑损伤有关。这些模式构成了一个通常被称为发作-发作间连续体（IIC）的频谱。迄今为止，尚无针对这些潜在有害脑电图模式管理的明确指南，这为重症监护医生带来了临床难题。在这里，我们回顾了各种 IIC 模式及其相关特征、癫痫发作风险和结果，并根据现有数据和专家意见提出了一种管理方法。
