Clinical and experimental data emphasize the importance of treating SE as a medical emergency. Ictal EEG abnormalities and motor phenomena represent different expressions of the same problem. As more information can be obtained with the help of EEG instrumentation there are concrete advantages of SE monitoring. If anti-epileptic drugs fail, and a refractory SE exists, general anesthetics are recommended in doses capable of producing EEG burst suppression.
We monitored 20 patients(12 males), age range 3 months-67 years in SE from different causes. Monitoring lasted 1-22 days. Whenever possible we used the following procedure: 8-16 channel EEG for better localization of abnormalities and planning of next procedures: then drug dose was increased (e.g. thiopental) until burst suppression occurred; next, a two-channel CSA monitor was added. We draw the following conclusions:
(1) with CSA help it was possible to detect the recurrence of crisis, as electrographic crisis may precede the clinical onset;
(2) it is simple to assess CNS drug effects, thus monitoring the dosage required to attain EEG burst suppression;
(3) intensive care staff can easily follow the procedure and actively participate in the monitoring;
(4) control of crisis was generally attained with doses far exceeding those recommended.