Long-Term Monitoring: An Overview

This chapter consists of two parts. In the first part, we will review the indications for longterm EEG monitoring in the diagnosis and management of epilepsy. This will include the differentiation of seizures and epilepsy, appropriate diagnostic and treatment options, the techniques and methods used in the EEG monitoring (ambulatory – hospital-based noninvasive and invasive video/EEG telemetry), commercially available monitoring systems, and presurgical evaluation of candidates for epilepsy surgery. In the second part, we will focus on the continuous EEG monitoring in the Intensive care unit (ICU). In doing so, we will describe which ICU patients should undergo continuous EEG (cEEG) monitoring; how long such patients should be monitored? We will review the epidemiology of nonconvulsive status epilepticus (NCSE) and the pathological EEG patterns commonly occurring in the critically ill patient, including NCSE and periodic epileptiform discharges (PEDs). We will discuss the methods which enable real time monitoring of seizures, and the adequate treatment of these seizures in a timely fashion. We will also discuss the hypothesis that progressive brain damage is occurring with NCSE or PEDs and also whether ICU patients with “controversial EEG patterns“ should receive aggressive treatment. Finally, we discuss the hypothesis that biomarkers, such as neuronspecific enolase (NSE), and magnetic resonance imaging (MRI) techniques (diffusion and perfusion MRI) as well as MRSpectroscopy, allow to detect the EEG patterns which might result from brain damage or are associated with it.