ACNS Standardized Critical Care EEG Terminology 2021 PDF

Summary

This document provides standardized terminology for critical care EEG. It includes a detailed list of abbreviations and diagrams associated with EEG, including the types and definitions of various EEG patterns and activities. The document also lists the authors and copyright information.

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Standardized Critical Care EEG Terminology L. J. Hirsch, et al. 2. Daily Seizure Burden can be calculated similarly: e.g., six 30- second seizures in one day would have a Daily Seizure Burden DIAGRAM LIST of 3 minutes....

Standardized Critical Care EEG Terminology L. J. Hirsch, et al. 2. Daily Seizure Burden can be calculated similarly: e.g., six 30- second seizures in one day would have a Daily Seizure Burden DIAGRAM LIST of 3 minutes. 1a. Asymmetry: voltage (mild) 1b. Asymmetry: frequency (mild) NOTE: Hourly pattern burden and hourly sei- 1c. Asymmetry (marked) zure burden can be calculated and reported in a similar 2. Continuity manner as the daily burdens, as can maximal hourly burden 3. Discharge vs. Burst of each. 4. Attenuation percent or Suppression percent 3. Daily Pattern Index is defined as Daily Burden X Mean 5. Localization of bursts Frequency (Hz). In the above example, if GPDs were at 1.5 6a. Highly Epileptiform Bursts Hz, the Daily GPD Index would be 5.2 h · 1.5 Hz ¼ 7.8 Hz- 6b. Highly Epileptiform Bursts hours. Similarly, an hourly pattern index can be described. For 7a. Identical Bursts example, 1.5-Hz LPDs with a prevalence of 20% for 1 hour 7b. Identical Bursts in a Stereotyped Cluster would have an hourly pattern index of 12 minutes · 1.5 Hz ¼ 8. State changes 18 Hz-mins. 9. Cyclic Alternating Pattern of Encephalopathy (CAPE) 10. Anterior-posterior (AP) gradient 11. Sporadic Epileptiform Discharges 12. Polyspike vs. BIRDs vs. Highly Epileptiform Burst ABBREVIATION LIST 13. Generalized Periodic Discharges (GPDs) ACNS ¼ American Clinical Neurophysiology Society 14. Lateralized Periodic Discharges (LPDs, unilateral) BI ¼ Bilateral Independent 15. Lateralized Periodic Discharges (LPDs, bilateral BIRDs ¼ Brief Potentially Ictal Rhythmic Discharges asymmetric) BTC ¼ Bilateral Tonic-Clonic 16. Lateralized Periodic Discharges (LPDs, bilateral CAPE ¼ Cyclic Alternating Pattern of Encephalopathy asynchronous) CCEMRC ¼ Critical Care EEG Monitoring Research 17. Bilateral Independent Periodic Discharges (BIPDs) Consortium 18. Unilateral Independent Periodic Discharges (UIPDs) ECSz ¼ Electroclinical seizure 19. Multifocal Periodic Discharges (MfPDs) ECSE ¼ Electroclinical status epilepticus 20. Periodic Discharges (PDs) EDs ¼ Epileptiform Discharges 21. Rhythmic Delta Activity (RDA) EDB ¼ Extreme Delta Brush 22. “Spike and Wave” or “Sharp and Wave” (SW) EEG ¼ Electroencephalography 23. Number of Phases ESE ¼ Electrographic status epilepticus 24. Evolution of frequency ESz ¼ Electrographic seizure 25. Evolution of morphology G ¼ Generalized 26. Evolution of location GPFA ¼ Generalized Paroxysmal Fast Activity 27. Fluctuating frequency Hz ¼ Hertz (i.e., per second) 28. Fluctuating morphology IIC ¼ Ictal-Interictal Continuum 29. Fluctuating location L ¼ Lateralized 30. Lateralized Periodic Discharges PLUS fast activity Mf ¼ Multifocal (LPDs1F) PDs ¼ Periodic Discharges 31. Rhythmic Delta Activity PLUS fast activity (RDA1F) RDA ¼ Rhythmic Delta Activity 32. Periodic Discharges PLUS RDA (PD1R) RPP ¼ Rhythmic or Periodic Pattern (i.e., PDs, RDA or 33. Generalized Rhythmic Delta Activity PLUS Spikes SW) (GRDA1S) SE ¼ Status epilepticus 34. Bilateral Independent Periodic Discharges PLUS fast SI ¼ Stimulus-Induced. activity (BIPDs1F) SIRPIDs ¼ Stimulus-Induced Rhythmic, Periodic or Ictal- 35a. Extreme Delta Brush (EDB) Appearing Discharges 35b. Extreme Delta Brush (EDB): RDA subtype ST ¼ Stimulus-Terminated 35c. Extreme Delta Brush (EDB): PDs subtype SW ¼ Spike-and-wave or sharp-and-wave 36a. Generalized Extreme Delta Brush (GEDB) UI ¼ Unilateral Independent 36b. Lateralized Extreme Delta Brush (LEDB) 1 ¼ Plus ¼ Additional feature which renders the pattern 36c. Bilateral Independent Extreme Delta Brush (BIEDB) more ictal-appearing than the usual term without the plus 37. Anterior-posterior (AP) lag 1F ¼ Superimposed fast activity 38. Electrographic seizure (ESz) 1R ¼ Superimposed rhythmic activity 39. Electroclinical seizure (ECSz) 1S ¼ Superimposed sharp waves or spikes, or sharply 40. Electroclinical seizure (ECSz) – for patients with prior contoured known epileptic encephalopathy clinicalneurophys.com Journal of Clinical Neurophysiology Volume 38, Number 1, January 2021 27 Copyright © by the American Clinical Neurophysiology Society. Unauthorized reproduction of this article is prohibited. L. J. Hirsch, et al. Standardized Critical Care EEG Terminology 41a. Brief Potentially Ictal Rhythmic Discharges (BIRDs) EEG 29c Ictal-Interictal Continuum (IIC) – Generalized (definite) EEG 30 Ictal-Interictal Continuum (IIC) with Quantitative 41b. Brief Potentially Ictal Rhythmic Discharges (BIRDs) EEG (QEEG) (definite) 41c. Brief Potentially Ictal Rhythmic Discharges (BIRDs) (definite) 41d. Brief Potentially Ictal Rhythmic Discharges (BIRDs) REFERENCES (possible) 1. Hirsch LJ, Brenner RP, Drislane FW, et al. The ACNS subcommittee 42. The Ictal-Interictal Continuum (IIC) on research terminology for continuous EEG monitoring: proposed standardized terminology for rhythmic and periodic EEG patterns encountered in critically ill patients. J Clin Neurophysiol 2005;22:128–135. 2. Hirsch LJ, LaRoche SM, Gaspard N, et al. American clinical Neuro- SUPPLEMENTAL DIGITAL CONTENT physiology Society’s Standardized Critical Care EEG Terminology: The “ACNS Standardized Critical Care EEG Terminology 2012 version. J Clin Neurophysiol 2013;30:1–27. 2021: Condensed Version” is available at Supplemental Digital 3. Gaspard N, Hirsch LJ, LaRoche SM, Hahn CD, Westover MB. Interrater agreement for critical care EEG terminology. Epilepsia 2014;55:1366–1373. Content, http://links.lww.com/JCNP/A149, and the “ACNS 4. Lee JW, LaRoche S, Choi H, et al. Development and feasibility testing of Standardized Critical Care EEG Terminology 2021: Reference a critical care EEG monitoring database for standardized clinical Chart” is available at Supplemental Digital Content, http://links. reporting and multicenter collaborative research. J Clin Neurophysiol 2016;33:133–140. lww.com/JCNP/A150. 5. Gaspard N, Manganas L, Rampal N, Petroff OA, Hirsch LJ. EEG LIST Similarity of lateralized rhythmic delta activity to periodic lateralized Supplemental figures are available as Supplemental Digital epileptiform discharges in critically ill patients. JAMA Neurol Content at http://links.lww.com/JCNP/A134. 2013;70:1288–1295. 6. Rodriguez Ruiz A, Vlachy J, Lee JW, et al. Association of periodic and EEG 1 Burst-attenuation pattern rhythmic electroencephalographic patterns with seizures in critically ill EEG 2 Burst-suppression pattern patients. JAMA Neurol 2017;74:181. EEG 3 Identical Highly-Epileptiform Bursts 7. 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Highly epileptiform bursts are associated with (UIPDs) seizure recurrence. J Clin Neurophysiol 2016;33:66–71. EEG 11 Unilateral Independent Rhythmic Delta Activity 11. Beniczky S, Hirsch LJ, Kaplan PW, et al. Unified EEG terminology and (UIRDA) criteria for nonconvulsive status epilepticus. Epilepsia 2013;54:28–29. 12. Leitinger M, Trinka E, Gardella E, et al. Diagnostic accuracy of the EEG 12 Multifocal Periodic Discharges (MfPDs) Salzburg EEG criteria for non-convulsive status epilepticus: a retrospec- EEG 13 LPDs (bilateral asymmetric) tive study. Lancet Neurol 2016;15:1054–1062. EEG 14 Generalized Spike-and-Wave (GSW) 13. Yoo JY, Rampal N, Petroff OA, Hirsch LJ, Gaspard N. Brief potentially ictal EEG 15 Stimulus Induced - GRDA (SI-GRDA) rhythmic discharges in critically ill adults. JAMA Neurol 2014;71:454–462. 14. Yoo JY, Marcuse LV, Fields MC, et al. Brief potentially ictal rhythmic EEG 16 LRDA with evolution discharges [B(I)RDs] in noncritically ill adults. 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