Brief potentially ictal rhythmic discharges [B(I)RDs] in noncritically ill adults

Ji Yeoun Yoo, Lara V. Marcuse, Madeline C. Fields, Jillian L. Rosengard, Maria Vittoria Traversa, Nicolas Gaspard, Lawrence J. Hirsch

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Introduction: Brief potentially ictal rhythmic discharges (B(I)RDs) have been described in neonates and critically ill adults, and their association with seizures has been demonstrated. Their significance in noncritically ill adults remains unclear. We aimed to investigate their prevalence, electrographic characteristics, and clinical significance. Methods: We identified adult patients with B(I)RDs who received long-term EEG recordings either in the epilepsy monitoring unit or in the ambulatory setting. Patients with acute findings on imaging or status epilepticus were excluded. B(I)RDs were defined as very brief (,10 seconds) runs of focal or generalized sharply contoured rhythmic activity greater than 4 Hz, with or without evolution, that were not consistent with any known normal or benign pattern. The clinical history, EEG, and imaging results were retrieved. Each patient with B(I)RDs was matched by age and etiology to a control group with epileptiform discharges but without B(I)RDs in a 1:2 ratio. Results: We identified B(I)RDs in 15 patients of 1,230 EEGs (1.2%). The pattern typically consisted of 0.5 to 4 second runs of sharply contoured alpha activity without evolution. All patients with B(I)RDs had epilepsy, and, when compared with controls with epilepsy but without BIRDs, were more likely to be medically refractory (10 of 15 [67%] vs. 5 of 30 [17%]; P , 0.01). All seizure onsets colocalized to the B(I)RDs, and most were morphologically similar. Conclusions: In noncritically ill patients, B(I)RDs are associated with refractory epilepsy and their location is correlated with the seizure onset area.

Original languageEnglish (US)
Pages (from-to)222-229
Number of pages8
JournalJournal of Clinical Neurophysiology
Volume34
Issue number3
DOIs
StatePublished - Jan 1 2017
Externally publishedYes

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Stroke
Epilepsy
Electroencephalography
Seizures
Status Epilepticus
Critical Illness
Newborn Infant
Control Groups

Keywords

  • B(I)RDs
  • Brief potentially ictal rhythmic discharges
  • Epilepsy
  • Medically refractory epilepsy
  • Nonconvulsive seizures
  • Seizures

ASJC Scopus subject areas

  • Physiology
  • Neurology
  • Clinical Neurology
  • Physiology (medical)

Cite this

Brief potentially ictal rhythmic discharges [B(I)RDs] in noncritically ill adults. / Yoo, Ji Yeoun; Marcuse, Lara V.; Fields, Madeline C.; Rosengard, Jillian L.; Traversa, Maria Vittoria; Gaspard, Nicolas; Hirsch, Lawrence J.

In: Journal of Clinical Neurophysiology, Vol. 34, No. 3, 01.01.2017, p. 222-229.

Research output: Contribution to journalArticle

Yoo, Ji Yeoun ; Marcuse, Lara V. ; Fields, Madeline C. ; Rosengard, Jillian L. ; Traversa, Maria Vittoria ; Gaspard, Nicolas ; Hirsch, Lawrence J. / Brief potentially ictal rhythmic discharges [B(I)RDs] in noncritically ill adults. In: Journal of Clinical Neurophysiology. 2017 ; Vol. 34, No. 3. pp. 222-229.
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AU - Yoo, Ji Yeoun

AU - Marcuse, Lara V.

AU - Fields, Madeline C.

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AU - Traversa, Maria Vittoria

AU - Gaspard, Nicolas

AU - Hirsch, Lawrence J.

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AB - Introduction: Brief potentially ictal rhythmic discharges (B(I)RDs) have been described in neonates and critically ill adults, and their association with seizures has been demonstrated. Their significance in noncritically ill adults remains unclear. We aimed to investigate their prevalence, electrographic characteristics, and clinical significance. Methods: We identified adult patients with B(I)RDs who received long-term EEG recordings either in the epilepsy monitoring unit or in the ambulatory setting. Patients with acute findings on imaging or status epilepticus were excluded. B(I)RDs were defined as very brief (,10 seconds) runs of focal or generalized sharply contoured rhythmic activity greater than 4 Hz, with or without evolution, that were not consistent with any known normal or benign pattern. The clinical history, EEG, and imaging results were retrieved. Each patient with B(I)RDs was matched by age and etiology to a control group with epileptiform discharges but without B(I)RDs in a 1:2 ratio. Results: We identified B(I)RDs in 15 patients of 1,230 EEGs (1.2%). The pattern typically consisted of 0.5 to 4 second runs of sharply contoured alpha activity without evolution. All patients with B(I)RDs had epilepsy, and, when compared with controls with epilepsy but without BIRDs, were more likely to be medically refractory (10 of 15 [67%] vs. 5 of 30 [17%]; P , 0.01). All seizure onsets colocalized to the B(I)RDs, and most were morphologically similar. Conclusions: In noncritically ill patients, B(I)RDs are associated with refractory epilepsy and their location is correlated with the seizure onset area.

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