{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T16:21:17Z","timestamp":1791908477166,"version":"4.3.4"},"reference-count":46,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2021,12,23]],"date-time":"2021-12-23T00:00:00Z","timestamp":1640217600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia Open"],"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Majority of seizures are detected within 24\u00a0hours on continuous EEG (cEEG). Some patients have delayed seizure detection after 24\u00a0hours. The purpose of this research was to identify risk factors that predict delayed seizure detection and to determine optimal cEEG duration for various patient subpopulations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively identified all patients \u226518\u00a0years of age who underwent cEEG at Cleveland clinic during calendar year 2016. Clinical and EEG data for all patients and time to seizure detection for seizure patients were collected.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty\u2010four hundred and two patients met inclusion criteria. Of these, 316 (13.2%) had subclinical seizures. Sixty\u2010five (20.6%) patients had delayed seizures detection after 24\u00a0hours. Seizure detection increased linearly till 36\u00a0hours of monitoring, and odds of seizure detection increased by 46% for every additional day of monitoring. Delayed seizure risk factors included stupor (13.2% after 48\u00a0hours, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.031), lethargy (25.9%, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.013), lateralized (LPDs) (27.7%, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.029) or generalized periodic discharges (GPDs) (33.3%, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.022), acute brain insults (25.5%, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.036), brain bleeds (32.8%, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.014), especially multiple concomitant bleeds (61.1%, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001), altered mental status (34.7%, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.001) as primary cEEG indication, and use of antiseizure medications (27.8%, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001) at cEEG initiation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>Given the linear seizure detection trend, 36\u00a0hours of standard monitoring appears more optimal than 24\u00a0hours especially for high\u2010risk patients. For awake patients without epileptiform discharges, &lt;24\u00a0hours of monitoring appears sufficient. Previous studies have shown that coma and LPDs predict delayed seizure detection. We found that stupor and lethargy were also associated with delayed seizure detection. LPDs and GPDs were associated with delayed seizures. Other delayed seizure risk factors included acute brain insults, brain bleeds especially multiple concomitant bleeds, altered mental status as primary cEEG indication, and use of ASMs at cEEG initiation. Longer cEEG (\u226548\u00a0hours) is suggested for these high\u2010risk patients.<\/jats:p><\/jats:sec>","DOI":"10.1002\/epi4.12572","type":"journal-article","created":{"date-parts":[[2021,12,16]],"date-time":"2021-12-16T12:22:09Z","timestamp":1639657329000},"page":"131-143","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Risk factors that predict delayed seizure detection on continuous electroencephalogram (cEEG) in a large sample size of critically ill patients"],"prefix":"10.1002","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6103-4250","authenticated-orcid":false,"given":"Ifrah","family":"Zawar","sequence":"first","affiliation":[{"name":"Epilepsy Center Neurological Institute Cleveland Clinic Cleveland Ohio USA"},{"name":"University of Virginia School of Medicine Charlottesville Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isaac","family":"Briskin","sequence":"additional","affiliation":[{"name":"Department of Quantitative Health Sciences Lerner Research Institute Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Hantus","sequence":"additional","affiliation":[{"name":"Epilepsy Center Neurological Institute Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,12,23]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1212\/01.WNL.0000125184.88797.62"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1212\/01.WNL.0000063316.47591.B4"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.55.1.117"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3181f07334"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000006689"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.47.1.83"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/WNP.0000000000000166"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/WNP.0000000000000165"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-013-2938-4"},{"issue":"3","key":"e_1_2_9_11_1","first-page":"170","article-title":"Guideline twelve: guidelines for long\u2010term monitoring for epilepsy","volume":"25","author":"American Clinical Neurophysiology Society","year":"2008","journal-title":"Am J Electroneurodiagnostic Technol"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-014-3369-6"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.24985"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e318211c19e"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2014.05.037"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3182703fbc"},{"issue":"10","key":"e_1_2_9_17_1","first-page":"1288","article-title":"Similarity of lateralized rhythmic delta activity to periodic lateralized epileptiform discharges in critically ill patients","volume":"70","author":"Gaspard N","year":"2013","journal-title":"JAMA Neurol"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.12270"},{"key":"e_1_2_9_19_1","first-page":"21","article-title":"A glossary of terms most commonly used by clinical electroencephalographers and proposal for the report form for the EEG findings. 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