Emergency Neurological Life Support: Status Epilepticus Continuous EEG is recommended for the management of ongoing SE and should be assessed frequently to monitor treatment effects; the optimal goal (seizure termination vs burst suppression vs complete suppression) is unknown at this time
Emergency Neurological Life Support Status Epilepticus Protocol Version 4 Pentobarbital: Load 5 mg kg, start infusion 1 mg kg hr titrated to EEG burst suppression, usual range 1-3 mg kg hr Continuous EEG monitoring is essential; if not available in your center, consider transfer to a regional center with this capability
Status Epilepticus - EMCrit Project If your center does not have continuous EEG monitoring, the patient will need to be transferred to a center that does Typically, the infusion is titrated to achieve burst suppression
Utility and rationale for continuous EEG monitoring: a primer for the . . . We provide a guide to the optimal timing and duration of EEG monitoring, the benefits of intracranial EEG for enhancing seizure detection, the impacts of ICU medications on EEG activity, and the importance of multidisciplinary care in ensuring safe and effective monitoring
UCSD STATUS EPILEPTICUS GUIDELINE * To order cEEG, look under “neurophysiology orderables” in EPIC, order “Prolonged EEG,” state “cEEG,” then page on-call EEG tech NCC MUST be consulted to order cEEG (or epilepsy attending willing to oversee cEEG q2-4h) cEEG only available 8am-8pm
ENLS: Neurocritical Care Societys Emergency Neurological Life Support . . . The course provides a mixture of didactic, case-based and evidence-based guideline review and workshops Pharmacotherapy and ICU EEG workshops utilize audience participation in on-screen quizzes and share protocols regarding osmotherapy for raised intracranial pressure and antiepileptic drug therapy
Continuous EEG Monitoring • LITFL• CCC 30 minute EEG lacks sensitivity for detecting NCS and NCSE in ICU settings may be used for risk stratification, e g if epileptiform discharges then extend monitoring may be performed serially, with increased sensitivity the greater the frequency an option in the absence of cEEG capacity, but still labour and resource intensive