Can J Neurol Sci
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Continuous EEG monitoring (CEEG) in the ICU is increasingly recognized as valuable means of monitoring cerebral function, otherwise inaccessible in the comatose patient. The principal applications are: monitoring for seizures and ischemia, guiding therapy for seizures and ischemia (especially vasospasm), adjusting levels of sedation for paralyzed or delirious patients, charting trends in brain function and prognosis. Continuous EEG monitoring is faced with numerous challenges: electrode failures (better electrodes are needed to replace standard EEG electrodes), documentation in the absence of a technologist, artifacts peculiar to ICU, prompt interpretation and review of large amounts of data, resource allocation and establishing the technology as being useful in improving outcomes and shortening ICU and hospital length of stay.
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Status epilepticus in the pediatric intensive care setting is a neurological emergency. Its management presents profound challenges for the pediatric intensivist, and neurologist. Understanding the neurobiological factors that are operative in transition of an epileptic seizure to self-sustained status epilepticus is critical to management. ⋯ The problem of refractory status epilepticus is particularly more frequently encountered in the intensive care setting. Therapeutic options in the initial management and in particular addressing reasons for the development of pharmacoresistance in status epilepticus are presented. Finally, data on outcome in the pediatric ICU setting is discussed providing thus an overview of our current understanding and state of the art in the management of status epilepticus in children.