Abstract
Small Cohorts have utilized PET and SPECT scans as complementary markers of metabolic activity in status epilepticus in patients with ictal-interictal EEG patterns (IIC). While some rhythmic/periodic discharges mandate termination, other IIC patterns reflect underlying stable brain lesions with no superimposed cerebral injury. We realize that perfusion mapping is not the greatest surrogate; however, it is more readily available. We suggest severe brain injury patients be treated with aggressive anticonvulsive treatment only when they fulfill all the following criteria: 1) altered mental status, 2) IIC EEG patterns, 3) periodic/rhythmic discharges colocalizing with hypermetabolism detected by loco-regional hyperperfusion and 4) significant decrease in hyperperfusion during a midazolam (MDZ) test.
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