As the population ages, technology improves, intensive caremedicine expands and neurocritical care advances, the use of EEGmonitoring in the critically ill is becoming increasinglyimportant.
This atlas is a comprehensive yet accessible introduction to theuses of EEG monitoring in the critical care setting. It includesbasic EEG patterns seen in encephalopathy, both specific andnon-specific, nonconvulsive seizures, periodic EEG patterns, andcontroversial patterns on the ictal–interictal continuum.Confusing artefacts, including ones that mimic seizures, are shownand explained, and the new standardized nomenclature for thesepatterns is included.
The Atlas of EEG in Critical Care explains the principlesof technique and interpretation of recordings and discusses thetechniques of data management, and 'trending' central to long-termmonitoring. It demonstrates applications in multi-modal monitoring,correlating with new techniques such as microdialysis, and featuressuperb illustrations of commonly observed neurologic events,including seizures, hemorrhagic stroke and ischaemia.
This atlas is written for practitioners, fellows and residentsin critical care medicine, neurology, epilepsy and clinicalneurophysiology, and is essential reading for anyone gettinginvolved in EEG monitoring in the intensive care unit.
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About the Author
Dr. Hirsch completed medical school and internship at YaleUniversity. He was resident and chief resident at the NeurologicalInstitute of New York where he also completed a two-year fellowshipin Epilepsy/EEG. He is currently Associate Clinical Professor ofNeurology at Columbia University and Director of the Continuous EEGMonitoring Program at New York-Presbyterian Hospital/ColumbiaUniversity Medical Center. His primary interest is providingclinical care for adolescents and adults with epilepsy, includingthose who are potential candidates for epilepsy surgery and indiagnosing "funny spells". His research interests includeeffectiveness and tolerability of antiepileptic drugs, brainmonitoring in the critically ill, brain stimulation for epilepsy,and cardiac effects of seizures.
Dr. Brenner has been on the faculty at the University ofPittsburgh since 1983, and is now clinical professor of neurologyand psychiatry. He has authored over 70 publications and was themedical editor of the American Journal of ElectroneurodiagnosticTechnology (2003-2006). He is a member of the American Academy ofNeurology (AAN), American Clinical Neurophysiology Society (ACNS),and the American Epilepsy Society (AES). He was director of theclinical EEG course for the AAN from 1991 through 1995 andco-director of the annual AES course in 2001. He was director ofclinical EEG courses for the ACNS from 2001-2003. He was presidentof the ACNS (2005-2006) and recently completed EEG on DVD-Adult: AnInteractive Reading Session.
Table of Contents
List of contributors.
1 EEG basics.
1.1 Electrode nomenclature, polarity and referential vs. bipolarmontages.
1.2 Normal EEG: awake and asleep.
2 EEG in encephalopathy.
2.1 Nonspecific patterns of encephalopathy.
2.2 Patterns suggesting specific diagnoses.
2.3 Findings in specific clinical scenarios.
2.4 Medication effects.
3 Seizures and status epilepticus.
4 Periodic discharges and other controversial EEGpatterns.
4.1 PLEDs, BIPLEDs, GPEDs and triphasic waves.
4.3 Standardized nomenclature.
5 EEG in cerebrovascular disease.
6 Artifacts that can mimic seizures or other physiologicpatterns.
7 Prolonged EEG monitoring and quantitative EEG techniquesfor detecting seizures and ischemia.
Figures 7.1-7.10 Quantitative EEG (QEEG) basics.
Figures 7.11-7.17 Basics of seizure detection.
Figures 7.18-7.21 Cyclic seizures and PLEDs.
Figures 7.22-7.25 Other QEEG techniques and uses in patientswith seizures.
Figures 7.26-7.31 Detecting other (non-seizure) events.
Figures 7.32-7.35 Long-term trends.
Figures 7.36-7.46 ICU artifacts.
Figures 7.47-7.48 Spreading depression/peri-injurydepolarizations.
Figures 7.49-7.54 Multimodality monitoring and intracranial EEGin the ICU.
8 Evoked and event-related potentials in the ICU.
8.1 Median nerve somatosensory evoked potentials.
8.2 Brainstem auditory evoked potentials.
8.3 Flash visual evoked potentials.
8.4 Event-related potentials.
Appendix ACNS Standardized EEG Research Terminology andCategorization for the investigation of rhythmic and periodicpatterns encountered in critically ill patients: July 2009version.
What People are Saying About This
"We highly recommend this atlas to all health care providers interpreting electroencephalograms of critically ill patients or managing critically ill patients who are undergoing EEG monitoring." (Epilepsy & Behavior, 6 October 2010)
"This unique atlas provides a reasonably comprehensive overview of common and controversial EEG patterns in the ICU, and is laden with practical pearls of interpretation. It should serve the interested intensivist well, and is an excellent starting point for neurologists and neurosurgeons interested in the evolving fields of neurocritical care and EEG monitoring." (Canadian Journal of Neurological Sciences, November 2010)