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Few Cerebral Hemorrhage Patients Undergo EEG in ICU

Last Updated: December 13, 2010.

Relatively few patients who suffer a cerebral hemorrhage undergo continuous electroencephalographic evaluation, which suggests that sub-clinical seizures often go undiagnosed, according to research presented at the annual meeting of the American Epilepsy Society, held from Dec. 3 to 7 in San Antonio.

MONDAY, Dec. 13 (HealthDay News) -- Relatively few patients who suffer a cerebral hemorrhage undergo continuous electroencephalographic (EEG) evaluation, which suggests that sub-clinical seizures often go undiagnosed, according to research presented at the annual meeting of the American Epilepsy Society, held from Dec. 3 to 7 in San Antonio.

Jeffrey M. Politsky, M.D., of the Northeast Regional Epilepsy Group in Summit, N.J., and colleagues reviewed the records of more than 950 patients admitted to the intensive care unit (ICU) between Jan. 1, 2007 and May 31, 2010, diagnosed with subdural hematoma, subarachnoid hemorrhage, or intracerebral hemorrhage, to see what proportion were diagnosed with sub-clinical seizures.

The researchers found that 20 percent of the patients received routine or continuous EEG evaluation; seizures were detected in a quarter of these patients, with no significant difference in seizure activity by type of hemorrhage. Continuous EEG detected seizures in a much higher percentage of patients than did routine EEG. In almost all cases, seizure activity was sub-clinical and compatible with a diagnosis of non-convulsive status epilepticus.

"Cerebral hemorrhage is a significant cause of sub-clinical seizure activity. The fact that over 700 patients with cerebral hemorrhage did not [undergo] EEG evaluation suggests that the diagnosis of sub-clinical seizures was missed in over 200 cases. Missing the diagnosis of sub-clinical seizures would be expected to have a negative impact on patient outcome, especially in this patient population. Continuous EEG is an important diagnostic tool in patients in the ICU setting and a more detailed analysis of the relationship of seizures in the acute setting of cerebral hemorrhage and outcome is warranted," the authors write.

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