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Chapter 6 - Rhythmic and Periodic Patterns (RPPs) and the Ictal‐Interictal Continuum (IIC)

from Part I - Introduction

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 focuses on rhythmic and periodic patterns (RPPs). These are common EEG patterns found in critically ill patients. The variety of different types of patterns and their standardized naming conventions are described here. These patterns span from serving as markers of encephalopathy, to markers of seizure risk (interictal), to status epilepticus itself (ictal), and everything in between. This broad potential of diagnostic significance is known as the ictal–interictal injury continuum (IIIC). This chapter describes strategies for differentiating between more benign and more malignant RPPs. Basic management strategies for these IIIC patterns are also described in this chapter.

Keywords

rhythmicperiodicdischargesdelta activitygeneralizedlateralizedbilateral independentunilateral independentictalinterictalcontinuumstatus epilepticus
Type
Chapter
Information
Critical Care EEG Basics
Rapid Bedside EEG Reading for Acute Care Providers
 , pp. 83 - 98
Publisher: Cambridge University Press
Print publication year: 2024

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References

Hirsch, LJ, Fong, MWK, 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):1–29.Google Scholar
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Gaspard, N, Hirsch, LJ, LaRoche, SM, et al. Interrater agreement for Critical Care EEG Terminology. Epilepsia. 2014 Sep;55(9):1366–73.Google Scholar
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Foreman, B, Mahulikar, A, Tadi, P, et al. Generalized periodic discharges and ‘triphasic waves’: A blinded evaluation of inter-rater agreement and clinical significance. Clinical Neurophysiology. 2016 Feb;127(2):1073–80.Google Scholar
Chong, DJ, Hirsch, LJ. Which EEG patterns warrant treatment in the critically ill? Reviewing the evidence for treatment of periodic epileptiform discharges and related patterns. Journal of Clinical Neurophysiology. 2005 Apr;22(2):79–91.Google Scholar
Rubinos, C, Reynolds, AS, Claassen, J. The ictal-interictal continuum: To treat or not to treat (and how)? Neurocritical Care. 2018 Aug;29(1):3–8.Google Scholar
Zafar, SF, Subramaniam, T, Osman, G, et al. Electrographic seizures and ictal-interictal continuum (IIC) patterns in critically ill patients. Epilepsy & Behavior. 2020 May;106:107037.Google Scholar

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