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A panel of international ICU and epilepsy physicians and researchers detail the epileptic phenomena that occur in the complex environment of the ICU. Focusing on the central nervous system, the authors systematically examine the most up-to-date evidenced-based data regarding ICU seizures, including their most frequent causes, their pathophysiology, their clinical presentation, and the diagnostic evaluation needed to confirm their presence. They also discuss the challenges and specifics of the management of ICU seizures, reviewing the new antiepileptics and their interaction with other ICU medications, drugs with epileptogenic properties used in the ICU, and the role of the new enterally available antiepileptics in treating seizures. Numerous tables summarize drug interactions, neuroimages reveal common ICU seizure etiologies, and multiple electroencephalographic recordings demonstrate clinical or subclinical seizures in ICU patients.
This book is designed to meet the need for a practically oriented textbook on the rapidly growing field of continuous EEG (cEEG) monitoring. A wide range of key clinical aspects are addressed, with explanation of status epilepticus classification, criteria for institution of monitoring, seizure patterns and their recognition, quantitative EEG analysis, and neuroimaging in patients undergoing cEEG monitoring. The value of cEEG and the nature of cEEG findings in various special situations are then reviewed, covering particular pathologies, critical care considerations, and prognostication. Treatments of nonconvulsive status epilepticus (NCSE) and nonconvulsive seizures (NCS) are discussed. The concluding section is devoted to important administrative issues including billing, staffing issues, comparison of EEG machines, and information technology (IT) issues.Continuous EEG monitoring offers the only reliable means of detecting seizures that are not clinically obvious in critically ill patients. Such seizures are common: approximately 20% of patients undergoing cEEG monitoring in hospital have NCSE or NCS. Against this background, many hospitals have started to offer cEEG monitoring as a basis for delivery of appropriate treatment. By presenting the state of the art in cEEG monitoring, this book will be invaluable to practitioners including neurophysiologists, neurologists, neurointensivists, intensivists, neurophysiology and epilepsy fellows, and neurology residents.
As the population ages, technology improves, intensive care medicine expands and neurocritical care advances, the use of EEG monitoring in the critically ill is becoming increasingly important. This atlas is a comprehensive yet accessible introduction to the uses of EEG monitoring in the critical care setting. It includes basic EEG patterns seen in encephalopathy, both specific and non-specific, nonconvulsive seizures, periodic EEG patterns, and controversial patterns on the ictal–interictal continuum. Confusing artefacts, including ones that mimic seizures, are shown and explained, and the new standardized nomenclature for these patterns is included. The Atlas of EEG in Critical Care explains the principles of technique and interpretation of recordings and discusses the techniques of data management, and 'trending' central to long-term monitoring. It demonstrates applications in multi-modal monitoring, correlating with new techniques such as microdialysis, and features superb illustrations of commonly observed neurologic events, including seizures, hemorrhagic stroke and ischaemia. This atlas is written for practitioners, fellows and residents in critical care medicine, neurology, epilepsy and clinical neurophysiology, and is essential reading for anyone getting involved in EEG monitoring in the intensive care unit.
Brain dysfunction is a major clinical problem in intensive care, with potentially debilitating long-term consequences for post-ICU patients of any age. The resulting extended length of stay in the ICU and post-discharge cognitive dysfunction are now recognized as major healthcare burdens. This comprehensive clinical text provides intensivists and neurologists with a practical review of the pathophysiology of brain dysfunction and a thorough account of the diagnostic and therapeutic options available. Initial sections review the epidemiology, outcomes, relevant behavioral neurology and biological mechanisms of brain dysfunction. Subsequent sections evaluate the available diagnostic options and preventative and therapeutic interventions, with a final section on clinical encephalopathy syndromes encountered in the ICU. Each chapter is rich in illustrations, with an executive summary and a helpful glossary of terms. Brain Disorders in Critical Illness is a seminal reference for all physicians and neuroscientists interested in the care and outcome of severely ill patients.
Mayo Clinic Critical and Neurocritical Care Board Review is a comprehensive review of critical care medicine and neurocritical care to assist in preparation of the neurocritical care and general critical care boards.
Seizures are frightening events. They frighten the patients who experience them; they frighten those who witness them; they also frighten many physicians who have to deal with them. Most individuals with seizures present to family physicians or to emergency room physicians. However, despite the fact that seizures are among the most common neurological conditions, most general practitioners, family practice specialists, and intemists do not see large numbers of patients with seizures. Given the apoplectic appearance of generalized tonic clonic convulsions, it is not difficult to understand why they arouse such emotional responses in those that experience them, those that witness them, and those whose care is sought for them. Seizures are symptoms of something wrong with the brain. Many different kinds of perturbations in brain anatomy, chemistry, or physiology can produce seizures. For many individuals, seizures occur in the context of an acute illness and will not recur once that illness is treated. These individuals do not have epilepsy. They have transient disturbances in brain function attributable to systemic medical conditions. It is important to recognize these issues, because, first, the seizure may be the initial, or even only, manifestation of the underlying medical problem and this needs to be recognized.
Pearls and take-home points highlighted in every chapter.
Although epilepsy is one of the nation's most common neurological disorders, public understanding of it is limited. Many people do not know the causes of epilepsy or what they should do if they see someone having a seizure. Epilepsy is a complex spectrum of disorders that affects an estimated 2.2 million Americans in a variety of ways, and is characterized by unpredictable seizures that differ in type, cause, and severity. Yet living with epilepsy is about much more than just seizures; the disorder is often defined in practical terms, such as challenges in school, uncertainties about social situations and employment, limitations on driving, and questions about independent living. The Institute of Medicine was asked to examine the public health dimensions of the epilepsies, focusing on public health surveillance and data collection; population and public health research; health policy, health care, and human services; and education for people with the disorder and their families, health care providers, and the public. In Epilepsy Across the Spectrum, the IOM makes recommendations ranging from the expansion of collaborative epilepsy surveillance efforts, to the coordination of public awareness efforts, to the engagement of people with epilepsy and their families in education, dissemination, and advocacy for improved care and services. Taking action across multiple dimensions will improve the lives of people with epilepsy and their families. The realistic, feasible, and action-oriented recommendations in this report can help enable short- and long-term improvements for people with epilepsy. For all epilepsy organizations and advocates, local, state, and federal agencies, researchers, health care professionals, people with epilepsy, as well as the public, Epilepsy Across the Spectrum is an essential resource.
Atlas of Intensive Care Quantitative EEG is the first resource fully dedicated to quantitative EEG (QEEG) analysis, tailored to any physician or EEG technologist who works with critically ill patients. With the rise of continuous EEG monitoring in intensive care, clinicians are increasingly called on to make real-time clinical judgments with little formal guidance on how to interpret QEEG. This book is configured to meet daily practice challenges. It addresses not only technical fundamentals but also provides numerous examples of signature QEEG patterns and artifacts to instruct both untrained and experienced eyes. Comprehensive in scope, this unique atlas walks the reader from essential principles all the way through to practical pattern recognition. With full-page reference samples pairing raw EEG with quantitative EEG spectrograms, brief clinical vignettes, and explanatory captions noting significant features, this book provides a roadmap for understanding and applying QEEG data in critically ill patients. Unrivaled in the breadth of its coverage and level of detail, its thorough discussions of both normal and abnormal findings and QEEG artifacts set the standard for effective use of quantitative electroencephalography and trend analysis in the ICU. Complete with a broad range of patterns and page after page of full-color samples, this book is designed to be the authoritative QEEG reference for neurologists, intensivists, technologists, and trainees working in critical care settings. Key Features: Includes full spectrum of abnormal ICU QEEG findings with multiple examples of each pattern to assist readers in recognizing the range of findings encountered in clinical practice Contains more than 400 full-page vivid color QEEG examples paired with raw EEG to build interpretive skills and enhance clinical decision-making Concise presentation of fundamental principles of QEEG Detailed analysis of QEEG artifacts that can be mistaken for abnormal findings
The only comprehensive source of information on this frequently misdiagnosed problem, with information critical for physicians, ER and ICU doctors, and psychiatrists. An under-recognized condition that can potentially cause brain damage and even death, nonconvulsive status epilepticus (NCSE) is an important clinical problem, occurring in about 25% of status epilepsy cases. Despite this prevalence, Nonconvulsive Status Epilepticus is the first comprehensive clinical text to cover its diagnosis and management. The book progresses logically, beginning with chapters discussing the history and classification of NCSE, reflecting a contemporary understanding of developmental, syndromic, and clinical aspects. Following chapters discuss relevant epidemiology, electrophysiology, imaging and pathophysiology of NCSE, with supplementary sections devoted to psychiatric and behavioral aspects of NCSE and to the different diagnostic considerations of its frequently unusual behavioral presentations. Highlights include: An emphasis on diagnosis, management, and all pertinent clinical issues A heavily illustrated section on EEG interpretation in NCSE Contributions by the foremost international experts on NCSE Throughout, the book maintains a practical focus on recognizing the key signs and symptoms of this subtly presented and clinically challenging condition. This multidisciplinary volume will provide physicians, ER and ICU doctors, and psychiatrists with a comprehensive source of information and opinion on nonconvulsive status epilepticus.