title: Ictal-interictal continuum: A proposed treatment algorithm.
abstract: The ictal-interictal continuum (IIC) is characterized by periodic and/or rhythmic EEG patterns that occur with relative high frequency in critically ill patients. Several studies have reported that some patterns seen within the continuum are independently associated with poor outcome. However there is no consensus regarding when to treat them or how aggressive treatment should be. In this review we examine peer-reviewed original scientific articles, guidelines and reviews indexed in PubMed and summarize current knowledge related to the ictal-interictal continuum. A treatment algorithm to guide management of critically ill patients with EEG patterns that fall along the IIC is proposed. The algorithm-based on best current practice in adults-takes into account associated clinical events, risk factors for developing seizures, response to medication trials and biomarkers of neuronal injury.
authors.affiliation: Cuban Neuroscience Center & Clinical-Surgical Hospital 'Hnos Ameijeiras', Cuba. Electronic address: valia.rodriguez@gmail.com.
authors.forename: Valia
authors.initials: V
authors.lastname: Rodríguez
authors.affiliation: Bon Secours Neurology Clinic, United States.
authors.forename: Meghan F
authors.initials: MF
authors.lastname: Rodden
authors.affiliation: Emory University School of Medicine, United States.
authors.forename: Suzette M
authors.initials: SM
authors.lastname: LaRoche
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D016638:Critical Illness / Q000628:therapy*; D004569:Electroencephalography / Q000379:methods* / Q000639:trends*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000639:trends*; D008297:Male; D012307:Risk Factors; D012640:Seizures / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D016896:Treatment Outcome
keywords: Continuous EEG monitoring; Critically ill patients; ICU; Ictal–interictal continuum; Periodic discharges; Rhythmic delta activity; Treatment algorithm