Cortical surface intracranial electrodes identify clinically relevant seizures missed on scalp EEG after traumatic intracranial hemorrhage

Chris R. Marcellino, Samuel Lapalme-Remis, Alejandro Rabinstein, Jamie Van Gompel, Gregory Alan Worrell, Eric T. Payne, Sara Hocker

Research output: Contribution to journalArticle

Abstract

Seizures and other electrophysiological disturbances are an under-recognized cause of coma, focal deficits, and prolonged encephalopathy following subdural hematoma evacuation. In these patients, it is possible that seizures remain unrecognized on scalp EEG. It has been shown that a high burden of seizures and other electrophysiological disturbances exist following surgical evacuation and underlie the encephalopathy commonly seen in this patient population, predisposing them to medical complications and confounding estimates of prognosis. As part of a research protocol, we are performing intraoperative placement of cortical surface (non-parenchyma penetrating) intracranial EEG on patients who present after trauma and require emergent decompressive hemicraniectomy. In this case report of a patient with high-velocity traumatic epidural, subdural, and subarachnoid hemorrhages, we identified frequent non-convulsive seizures or seizure-like SIRPIDs with intracranial cortical surface monitoring that were not identified on simultaneous scalp EEG. Stimulation consistently triggered these electrographic seizures in addition to rhythmic lateralized periodic discharges. His mental status improved rapidly after resolution of these electrographic seizures shortly after increasing antiseizure medications, suggesting that they may have been contributing to his encephalopathy. More research is needed to determine the frequency of this phenomenon and determine whether treatment of such seizures improves patient outcomes.

Original languageEnglish (US)
Pages (from-to)551-556
Number of pages6
JournalEpileptic Disorders
Volume20
Issue number6
DOIs
StatePublished - Dec 1 2018

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Traumatic Intracranial Hemorrhage
Scalp
Electroencephalography
Electrodes
Seizures
Brain Diseases
Subdural Hematoma
Subarachnoid Hemorrhage
Coma
Research

Keywords

  • hematoma
  • intracranial EEG
  • subdural
  • trauma
  • traumatic brain injury

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Cortical surface intracranial electrodes identify clinically relevant seizures missed on scalp EEG after traumatic intracranial hemorrhage. / Marcellino, Chris R.; Lapalme-Remis, Samuel; Rabinstein, Alejandro; Van Gompel, Jamie; Worrell, Gregory Alan; Payne, Eric T.; Hocker, Sara.

In: Epileptic Disorders, Vol. 20, No. 6, 01.12.2018, p. 551-556.

Research output: Contribution to journalArticle

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