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Chapter 10 - Management of the Ictal‐Interictal Continuum (IIC)

from Part II - Case-Based Approach to Specific Conditions

Published online by Cambridge University Press:  22 February 2024

Neville M. Jadeja  and
Kyle C. Rossi
Neville M. Jadeja
Affiliation:
University of Massachusetts Medical School
Kyle C. Rossi
Affiliation:
University of Massachusetts Medical School
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Summary

This chapter describes the practical aspects of recognizing and managing electrographic patterns that may constitute an ictal–interictal injury continuum (IIIC) using a case-based approach. Plus [+] modifiers include superimposed fast activity (+F), spike/sharp activity (+S), or rhythmic delta activity (+R). If present, these features suggest the pattern is more likely associated with ictal activity. Evolution refers to at least two distinct changes in either frequency, morphology, or location with time and is an electrographic hallmark of seizures. Patterns that do not qualify for definite electrographic seizures but may still contribute to deterioration of neurological function may be referred to the IIIC and should be managed appropriately. Finally, the chapter describes nonictal and stimulus induced patterns.

Keywords

plus termsevolutionictal activityictal–interictal injury continuuminterictal patternsstimulus induced patternsSIRPIDs
Type
Chapter
Information
Critical Care EEG Basics
Rapid Bedside EEG Reading for Acute Care Providers
 , pp. 144 - 159
Publisher: Cambridge University Press
Print publication year: 2024

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References

Hirsch, LJ, Fong, MW, Leitinger, M, et al. American Clinical Neurophysiology Society’s Standardized Critical Care EEG Terminology: 2021 version. Journal of Clinical Neurophysiology. 2021 Jan 1;38(1):1.Google Scholar
Johnson, EL, Kaplan, PW. Population of the ictal-interictal injury zone: The significance of periodic and rhythmic activity. Clinical Neurophysiology Practice. 2017 Jan 1;2:107–18.Google Scholar
Gelisse, P, Crespel, A, Genton, P, Jallon, P, Kaplan, PW. Lateralized periodic discharges: Which patterns are interictal injury, ictal, or peri-ictal? Clinical Neurophysiology. 2021 Jul 1;132(7):1593–603.Google Scholar
Hirsch, LJ, Claassen, J, Mayer, SA, Emerson, RG. Stimulus‐induced rhythmic, periodic, or ictal discharges (SIRPIDs): A common EEG phenomenon in the critically ill. Epilepsia. 2004 Feb;45(2):109–23.CrossRefGoogle ScholarPubMed
Braksick, SA, Burkholder, DB, Tsetsou, S, et al. Associated factors and prognostic implications of stimulus-induced rhythmic, periodic, or ictal discharges. JAMA Neurology. 2016 May 1;73(5):585–90.Google Scholar

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