Rendement de l'EEG intermittent répété pour la detection des crises chez les patients adultes en réanimation

Introduction Seizures are common in critically ill patients and prevalence can exceed 30% in the neuro-intensive care unit (ICU). Continuous EEG monitoring (cEEG) is the gold standard for seizure detection in critically ill patients. Objectives To determine the yield of intermittent EEG (iEEG) to detect critically ill adult patients with seizures and to identify the factors that affect this yield. Methods We retrospectively analyzed cEEG data and medical records from 977 consecutive critically ill patients undergoing cEEG. We included those presenting at least one electrographic seizure during the first 24 hours of cEEG. Patients with hypoxic-ischemic encephalopathy were excluded. For seizure detection, we reviewed six 30-minute epochs on cEEG selected at H0, H3, H6, H12, H18 and H24. Results Seizures occurred in 10.75% (105/977) of patients. Level of consciousness was impaired in 79 (75%) of patients, with 42 (40%) in coma. Review of the H0 epoch on cEEG permitted to detect seizures in 61 (58%) patients. These figures increased to 70 (67%), 75 (71%), 91 (87%) and 97 (92%) patients for a sampling every 24, 12, 6 and 3 hours, respectively (P = 0.02). Frequency of seizures on cEEG was the only factor significantly affecting the probability of seizure detection. Sampling every 6 hours revealed seizures in all patients with more than six seizures per 24 hours. Conclusions iEEG repeated every 6 hours can accurately detect patients presenting seizures, especially when seizure frequency is greater than six per 24 hours. These findings have practical implications for electrographic seizure detection in critically ill patients in settings lacking cEEG.SCOPUS: ar.j