Multimodal invasive monitoring in status epilepticus: What is the evidence it has a place?

Authors

  • Raimund Helbok,

    Corresponding author
    • Department of Neurology, Division of Neurocritical Care, Innsbruck Medical University, Innsbruck, Austria
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  • Jan Claassen

    1. Division of Critical Care Neurology, Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, U.S.A
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Address correspondence to Raimund Helbok, Department of Neurology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria, E-mail: raimund.helbok@uki.at

Summary

The underlying pathophysiology of status epilepticus (SE) remains mostly invisible to the clinician in the intensive care unit (ICU) setting. In animal studies associated hemodynamic and brain neurochemical changes have been well described. In the last decade, bedside invasive neuromonitoring techniques allow the assessments of changes in focal and global cerebral physiology associated with ictal activity on the tissue level in humans. Recent studies demonstrate that laboratory research insufficiently replicates the complexity of the human condition. Herein we summarize the current knowledge gained from human studies integrating cortical electrographic and brain tissue metabolic and hemodynamic information into the current pathophysiologic concept of SE in humans. With increasing experience gained by the use of extended neuromonitoring, we are more and more able to understand associated hemodynamic and brain neurochemical changes in patients with SE. In the future, this information can potentially provide integrated pathophysiologic end points into SE treatment concepts.

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