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Annual Course 2014: Seizures and EEG in the Critically Ill Patient

Recorded December 2014

Overview

The Annual Course focuses on diagnosis and management of seizures in patients admitted to intensive care units (ICU), both those with known epilepsy and those with seizures due to systemic illnesses or infection.
Topics include: diagnostic challenges, initially regarding etiologies of seizures in ICU patients; how routine and / or continuous EEG can help (or hinder) management. Financial issues and management options for patients having seizures as well as Status Epilepticus in ICU settings.
Lectures cover standard anticonvulsants, sedative and coma-inducing agents, as well as non-standard treatments such as surgery, diet, immunomodulatory agents, and TMS. The Annual Course concludes with a discussion of prognosis and outcomes from seizures as well as status epilepticus. The course includes case presentation, debate and use of audience response system.

Learning Objectives

  • Recognize interictal and ictal EEG patterns in critically ill patients
  • Define intervention strategies for critically ill patients with both subclinical
    and refractory clinical Status Epilepticus
  • Implements rational medical therapy for seizures in critically ill patients
  • Counsel families regarding implications and prognosis of sub-clinical and clinical Status Epilepticus
  • Assist physicians in treating subclinical and clinical seizures through use of appropriate medications
  • Recognize the implications of seizures in a critically ill patient who survived and is now facing neuropsychological difficulties.
Target Audience
Intermediate and Advanced (see page 120 for details)Program
Chair: Eric Kossoff, M.D.

Diagnostic Challenges
Introduction to Morning Session
Eric Kossoff, M.D.

Case Presentation (Johnny, Part 1)
Andreas Alexopoulos, M.D., M.P.H.

Lecture: Etiologic Considerations in Seizure Screening
Nicholas S. Abend, M.D.
Lecture: EEG in the ICU: Nomenclature and Current Trends
Susan T. Herman, M.D.

Debate: Utility of Continuous EEG – Monitor All vs. Be Selective?
Lawrence J. Hirsch, M.D. (Pro) / Paul Vespa, M.D. (Con)

Case (Johnny, Part 2)
Lily Wong-Kisiel, M.D.

Lecture: Neonates and Children: Are They Different?
Cecil Hahn, M.D.
Lecture: NORSE, FIRES, and Encephalitis
Nicolas Gaspard, M.D., Ph.D.

Flash Panel: Financial and Logistical Issues
Is Continuous EEG Worth the Cost and Use of Resources?, Thomas P. Bleck, M.D.
Neurointensivist, Edward M. Manno, M.D.

Morning Wrap-Up
Eric Kossoff, M.D.

Treatment Challenges

Introduction to Afternoon Session
Eric Kossoff, M.D.

Case (Johnny, Part 3)
Jack Lin, M.D.
Lecture: Pharmacologic Treatment of Status Epilepticus in the ICU
Daniel H. Lowenstein, M.D.

Lecture: Pharmacologic Treatment of Super-refractory Status Epilepticus
Joseph I. Sirven, M.D.
Debate: Should We Treat Anoxic / Myoclonic Seizures?
David M. Ficker, M.D. (Pro) / Jennifer L. Hopp, M.D. (Con)
Lecture: AES Treatment Guidelines for Status Epilepticus
Tracy A. Glauser, M.D.

Flash Panel: Other Treatments To Try When Nothing Else Works
Surgery, Yu-tze Ng, M.D.
Ketogenic Diet, Mackenzie Cervenka, M.D.

Steroids / IVIG – How Do They Work?
Annamaria Vezzani, Ph.D.
Transcranial Magnetic Stimulation
Alexander Rotenberg, M.D., Ph.D.

Lecture: Long-term Prognosis and Outcomes
Elizabeth J. Waterhouse, M.D.

Case (Johnny, Part 4 and Conclusion)
Jerzy P. Szaflarski, M.D., Ph.D.

Conclusions
Eric Kossoff, M.D.

ABPN Core Competencies
The American Board of Psychiatry and Neurology has reviewed the Annual Course Symposium and has approved this program as part of a comprehensive lifelong learning program, which is mandated by the ABMS as a necessary component of maintenance of certification. Core Competencies: Patient Care, Medical Knowledge and Practice-based Learning