From the Guidelines
SIRPID on EEG is a concerning finding that indicates significant underlying brain dysfunction, and its presence is associated with higher mortality rates, but it should not dictate treatment decisions or prognostication without considering the overall clinical context. The prognosis associated with SIRPIDs is generally poor, as they are most commonly seen in patients with acute brain injuries, particularly those in comatose states. According to the 2024 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations 1, the American Clinical Neurophysiology Society defines the ictal-interictal continuum as rhythmic or periodic patterns that are considered to be possible seizure or status epilepticus even without fulfilling strict electrographic criteria.
Some key points to consider in the management of SIRPIDs include:
- The importance of consistent definitions when investigating this topic and creating treatment recommendations, as emphasized in the 2024 consensus statement 1
- The need for skilled interpretation of video EEG to correctly categorize EEG findings, as highlighted in the same study 1
- The potential benefits of treating clinical seizures, despite the lack of high-certainty evidence, as suggested in the 2023 American Heart Association focused update on adult advanced cardiovascular life support 1
- The uncertainty surrounding the treatment of nonconvulsive seizures and status epilepticus, as noted in the TELSTAR trial 1
- The potential benefits of continuous EEG monitoring in detecting epileptiform activity, including seizures and status epilepticus, after cardiac arrest, as discussed in the 2023 update 1
In terms of treatment, the use of antiseizure medications, such as propofol, valproate, and levetiracetam, may be effective in suppressing clinical seizures and electrographic seizures, but the decision to treat should be made on a case-by-case basis, taking into account the individual patient's clinical context and the potential risks and benefits of treatment. As noted in the 2024 consensus statement 1, there is no direct evidence of undesirable effects of antiseizure medications in comatose post–cardiac arrest patients, although the use of sedating agents may delay awakening.
Overall, the management of SIRPIDs should focus on treating the underlying condition, monitoring for clinical seizures, and using antiseizure medications judiciously, while also considering the potential benefits and risks of continuous EEG monitoring.
From the Research
SIRPIDs Meaning on EEG
- SIRPIDs stand for Stimulus-Induced Rhythmic, Periodic, or Ictal Discharges, which are EEG patterns that are consistently induced by alerting stimuli in critically ill patients 2.
- These patterns can include periodic epileptiform discharges, rhythmic patterns, or ictal-appearing discharges, and can be lateralized or unilateral 2.
Prognosis of SIRPIDs
- The presence of SIRPIDs has been associated with a higher incidence of clinical status epilepticus, particularly in patients with focal or ictal-appearing SIRPIDs 2.
- However, the prognostic significance of SIRPIDs is still unclear, and further research is needed to determine their impact on patient outcomes 2, 3.
- The treatment of SIRPIDs is also unclear, but antiepileptic drugs such as levetiracetam may be used to control seizures in patients with SIRPIDs 4, 5, 6.
Clinical Significance of SIRPIDs
- SIRPIDs can be differentiated from spontaneous seizures by recording video, documenting patient stimulation, or repetitively examining patients during continuous EEG monitoring 2.
- The recognition of SIRPIDs is important, as they can have significant implications for patient care and management, particularly in critically ill patients 2, 3.