PMC3399402_01
Initial EEG showing sustained typical spike-and-wave activity (TSWA) with 3 Hz average frequency, uniform morphology, bilateral synchrony, bilateral symmetry, widespread distribution, and bifrontal voltage maximum.. Notes: Clinically, the patient was in coma with no voluntary movements. The epoch shown was recorded approximately 53 hours after the first hypoxic-ischemic event, 32 hours after the episode of ventricular fibrillation in the ICU, and 23 hours after loading fosphenytoin and discontinuing lorazepam. TSWA persisted after lorazepam 4-mg and levetiracetam 500-mg was given intravenously.
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The EEG showed sustained typical spike-and-wave activity (TSWA) confirming NCSE and indicating typical absence status epilepticus (Fig. 1).
EEG showing persistent TSWA with somewhat lower average frequency (compare with Fig. 1).. Note: The epoch shown was recorded approximately 10 minutes after the patient received two boluses of midazolam 0.2 mg/kg and initiation of midazolam drip at a rate of 0.05 mg/kg/hour.
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TSWA, albeit with somewhat lower discharge frequency (Fig. 2).
EEG showing "fragmentation" of TSWA due to intermittent suppression of spike-and-wave activity.. Note: The epoch shown was recorded approximately 10 minutes after the midazolam infusion rate was increased to 0.5 mg/kg/hour. Midazolam was further titrated; an infusion rate of 1.2 mg/kg/hour resulted in disappearance of TSWA and appearance of burst-suppression in the EEG (not shown).
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The infusion rate was increased and at 0.5 mg/kg/hour the EEG showed intermittent suppression of spike-and-wave discharges (Fig. 3). The midazolam infusion rate was further increased to achieve EEG burst-suppression.