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Nonconvulsive Seizures and Periodic Discharges: No Longer Such Innocent Bystanders

Commentary Nonconvulsive seizures (NCS) and periodic discharges are some of the most common findings on EEG in neurocritically ill patients, and some combination of these patterns is seen every single day in reasonably large institutions. Given the prevalence of these findings as well as its long historical recognition, it is somewhat surprising that we still do not necessarily understand their significance particularly well, in part because of the wide morphologic variability in their presentations across many different etiologies. Studies have shown association with poor outcome with some of these patterns, but definitive studies implicating a direct relationship have been sparse. Specifically, the question as to whether NCS and periodic patterns on EEG are mechanistically involved in causing morbidity or whether they are mere bystanders/markers of acute brain injury has been at the forefront of this line of research since continuous EEG (cEEG) studies had demonstrated a high prevalence of these patterns in critically ill patients. Two recent studies have helped illuminate the significance of these patterns. Seizure Burden in Subarachnoid Hemorrhage Associated With Functional and Cognitive Outcome.