Continuous EEG (cEEG)
Cortical electrical activity recorded continuously at the bedside, the only non-invasive tool that detects non-convulsive seizures and the canonical reference for SE drug-titration endpoints.
1. Bedside vignettes: why this matters in the PICU
Vignette A. Post-arrest day 1, IIC or seizure?
A 6-year-old post out-of-hospital VF arrest, ROSC at 28 minutes, targeted temperature 33°C. Day 1: GCS 3 sedated; aEEG shows discontinuous pattern with intermittent bursts. cEEG (10–20 system) shows lateralised periodic discharges at 1.5 Hz with sharp morphology over the right hemisphere, lasting 30 seconds and recurring every 3 minutes. The bedside team asks: is this NCSE (treat) or the ictal-interictal continuum (less clear-cut)? Per ACNS 2021, frequency > 2.5 Hz with evolution is electrographic seizure; this is IIC. The team trials a midazolam bolus, the LPDs resolve, and the team interprets the resolution as functional evidence the LPDs were ictal: continue antiseizure therapy.
Vignette B. Refractory status epilepticus in a 5-year-old, the drug ladder
A 5-year-old with prolonged febrile seizure that has continued for 30 minutes despite two doses of midazolam IM and IV lorazepam. cEEG confirms ongoing generalised electrographic seizure. Per ESETT, second-line is levetiracetam 60 mg/kg IV, fosphenytoin 20 mg PE/kg IV, or valproate 40 mg/kg IV (all three equivalent in efficacy). The team chooses levetiracetam (least sedating). The clinical seizure stops; cEEG shows resolution of the electrographic seizure 10 minutes later. The team continues cEEG for 24 hours and detects two further brief electrographic seizures without clinical correlate, which they treat. Without cEEG, those NCSE episodes would be missed.
Vignette C. SAH day 6, qEEG alpha-delta ratio falls 6 hours before clinical signs of DCI
A 16-year-old with aneurysmal SAH post-coiling, day 6. cEEG running since day 2. Quantitative trends show the alpha-delta ratio (ADR) falling from 0.55 to 0.35 over 6 hours, which is statistically significant per the centre's algorithm. TCD MFV is rising in parallel but Lindegaard ratio is only 2.8 (borderline). The team escalates haemodynamics, repeats angiography (which confirms moderate vasospasm in the right MCA), and the patient is treated successfully. The clinical examination remained unchanged during the 6-hour ADR decline; qEEG was the earliest signal.
2. What EEG is, and what it is not
EEG records the summated post-synaptic potentials of cortical pyramidal neurons, measured at the scalp via differential amplification between electrode pairs. The signal amplitude at the scalp is ~10–100 μV, attenuated by the skull and scalp by a factor of ~100 from the underlying cortical surface.
Five things follow.
EEG samples cortex only. Deep structures (basal ganglia, thalamus, brainstem) are not directly seen on scalp EEG. Subcortical seizures (e.g., from a deep mesial focus) may show only as secondary cortical propagation.
EEG is highly state-dependent. Sedation, hypothermia, neuromuscular blockade, hypoglycaemia, and metabolic encephalopathy all change the baseline. Reading EEG requires knowing the clinical state.
EEG distinguishes NCSE from other altered-consciousness causes. This is its most uniquely valuable contribution: NCSE causes ~20% of comatose ICU patients' altered consciousness and is invisible without continuous monitoring.
EEG-based SE management has trial evidence. ESETT (second-line drugs) and ECLIPSE-SE (third-line) have established the modern drug ladder for SE. Endpoint definitions (electrographic seizure resolution, burst suppression) are EEG-based.
EEG is not seizure-detector only. Background continuity, reactivity, and pattern (e.g., GPD, LPD) carry independent prognostic and diagnostic information.
Reactivity matters as much as the pattern itself. A patient with sustained burst suppression who reactivates to a painful stimulus has a much better prognosis than one whose suppression is unchanged. Test reactivity before reading prognosis from the resting trace.
Pediatric EEG differs by age in three important ways. (1) Background frequencies mature from delta (newborn) through theta (toddler) to alpha (school-age and adolescent); a "slow" trace in a 1-year-old is normal but pathological in a 14-year-old. (2) Seizure semiology in neonates is often subtle or invisible clinically; cEEG detects ~50% more seizures than clinical exam in neonates. (3) NCSE prevalence is higher in pediatric ICU than in adult ICU (some studies suggest 30–40% of comatose pediatric ICU patients).
3. Montage and electrode placement
Electrode placement. The 10-20 international system places electrodes at proportional distances (10% or 20%) along the head circumference. Standard adult ICU montage uses 19 electrodes plus a reference. Pediatric NICU/PICU montages often reduce to 9 or 11 electrodes (less coverage but faster placement, less coverage but better fit on small heads).
Montages. Two principal display modes:
- Bipolar (longitudinal "Banana"): each channel shows the difference between two adjacent electrodes. Useful for localising focal patterns; "phase reversal" in bipolar identifies the seizure focus.
- Referential (average reference): each channel shows one electrode against an average of all others. Useful for global pattern recognition (burst suppression, generalised discharges).
Bedside teams often run both simultaneously and switch view depending on the question.
Pediatric considerations. Neonatal EEG uses a reduced montage (typically Fp1, Fp2, C3, C4, T3, T4, O1, O2, Cz; 9 electrodes) per ACNS 2013 neonatal guidelines. Head size, scalp thinness, and the need to balance coverage against placement time guide the choice.
4. The signal: bands, rhythms, reactivity, continuity
A bedside EEG reading covers four dimensions:
Frequency bands (the basic vocabulary):
| Band | Frequency | Where it appears normally |
|---|---|---|
| Delta | 0.5–3 Hz | Deep sleep, newborns awake |
| Theta | 4–7 Hz | Toddlers awake; drowsiness in older children |
| Alpha | 8–12 Hz | Awake adult posterior dominant rhythm (PDR) |
| Beta | 13–30 Hz | Frontal in awake adult; often pharmacological |
| Gamma | > 30 Hz | High cognition; mostly outside ICU concern |
Rhythms: posterior dominant rhythm (PDR) is the canonical awake-resting alpha over occipital cortex; loss of PDR is a non-specific marker of encephalopathy.
Reactivity: does the background change when the patient is stimulated (loud noise, painful stimulus)? Reactive background is favourable; unreactive is concerning regardless of the resting frequency.
Continuity: is the background continuous (always present) or discontinuous (bursts separated by silence)? Severely discontinuous patterns (suppression, burst-suppression) reflect deep encephalopathy or anaesthesia.
Continuity + reactivity + dominant frequency is the three-axis snapshot every bedside team should chart. A discontinuous, unreactive, low-amplitude trace in an unsedated patient is severe; a continuous, reactive, alpha-dominant trace is essentially normal.
5. ACNS 2021 terminology: GPD, LPD, RDA, BIRDS, IIC
The ACNS 2021 standardised terminology is the modern reference for ICU EEG reading. The key categories:
| Category | Acronym | What it is |
|---|---|---|
| Generalised periodic discharges | GPD | Sharp waves recurring at regular intervals across both hemispheres |
| Lateralised periodic discharges | LPD | Same but over one hemisphere |
| Rhythmic delta activity | RDA | Continuous 0.5–4 Hz waves, lateralised or generalised |
| Brief intermittent rhythmic discharges | BIRDS | Short (< 10 s) rhythmic bursts |
| Ictal-interictal continuum | IIC | Pattern that does not meet seizure criteria but is concerning |
Seizure criteria (ACNS 2021): rhythmic activity > 2.5 Hz with evolution in frequency, location, or morphology lasting ≥ 10 seconds; OR rhythmic activity ≤ 2.5 Hz with clinical correlate; OR repeated rhythmic activity meeting threshold.
The IIC dilemma: many patterns (LPDs at 1–2 Hz, GPDs at 1.5 Hz, rhythmic delta) are below the seizure cutoff but may still drive metabolic distress. The bedside approach: trial of antiseizure medication; resolution of the pattern and clinical/electrographic improvement supports an ictal interpretation. Non-resolution suggests interictal or post-ictal pattern.
6. Pattern library: what to recognise on cEEG
| Pattern | Meaning | Action |
|---|---|---|
| Continuous alpha-dominant | Normal awake adult | None |
| Continuous theta-dominant | Mild encephalopathy or drowsy | Investigate; usually metabolic / mild |
| Continuous delta-dominant | Moderate encephalopathy | Investigate; metabolic, structural, or post-ictal |
| Discontinuous | Severe encephalopathy or deep anaesthesia | Investigate cause; consider sedation withdrawal trial |
| Burst suppression | Deep anaesthesia, severe HIE, barbiturate coma | Context-dependent; SE endpoint if therapeutic |
| Isoelectric (flat) | Cerebral electrical silence | Severe HIE, brain death (with ancillary testing), drug overdose |
| GPD (generalised periodic discharges) | IIC, post-anoxic, sepsis-associated encephalopathy | Consider antiseizure trial; pair with clinical |
| LPD (lateralised periodic discharges) | Focal cortical injury, focal SE | Consider antiseizure trial; investigate structural cause |
| Electrographic seizure | Rhythmic > 2.5 Hz with evolution | Treat per SE protocol |
| RDA (rhythmic delta) | IIC; less ictal than LPD/GPD | Trial antiseizure if encephalopathic |
| BIRDS | Brief (< 10 s) rhythmic discharges | Often pre-ictal; monitor closely |
7. Try it: interactive widgets
8. Status epilepticus management section
The modern SE ladder is based on trial evidence (ESETT, ECLIPSE-SE, RAMPART). EEG is used at three points: (1) confirming initial diagnosis (especially NCSE), (2) titrating second- and third-line therapy, (3) defining endpoints (electrographic seizure resolution; burst suppression for super-refractory).
8.1 First-line: benzodiazepines
- Midazolam 0.2 mg/kg IM (max 10 mg) per RAMPART, or lorazepam 0.1 mg/kg IV (max 4 mg).
- Repeat once if seizure continues at 5 minutes.
8.2 Second-line: ESETT-equivalent
ESETT (Kapur 2019) compared levetiracetam 60 mg/kg, fosphenytoin 20 mg PE/kg, valproate 40 mg/kg. All three were equivalent at 60 minutes. Choose by patient context:
- Levetiracetam: least sedating, no hepatic interactions; often first choice.
- Fosphenytoin: established, but cardiac monitoring required.
- Valproate: avoid in hepatic disease, suspected metabolic disease, age < 2 years.
8.3 Third-line (refractory SE)
Continuous IV anaesthetic infusion:
- Midazolam 0.2 mg/kg bolus, then 0.05–2 mg/kg/h infusion.
- Propofol 1–2 mg/kg bolus, then 1–4 mg/kg/h (caution in children, risk of PRIS).
- Pentobarbital 5–15 mg/kg load, then 1–5 mg/kg/h (super-refractory; reserved when above fails).
EEG endpoint: resolution of electrographic seizures for refractory; burst suppression (typically 60% suppression ratio for 24 hours) for super-refractory.
8.4 ECLIPSE-SE (third-line trial)
ECLIPSE-SE (Kapur 2019) is the ongoing trial comparing midazolam vs propofol vs pentobarbital for RSE in adults; pediatric extension data are accumulating. Until results are definitive, choice is centre- and clinician-dependent.
Decision support, not a clinical protocol. Every drug, dose, and endpoint above is age-, centre-, and patient-dependent. Defer to your unit's protocols and senior clinical team.
9. Clinical contexts: cEEG across acute brain injuries
9.1 Convulsive and non-convulsive status epilepticus
The canonical indication. NCSE causes ~20% of comatose ICU patients' altered consciousness. cEEG is the only way to detect it. ESETT and ECLIPSE-SE define the modern drug ladder.
9.2 HIE and post-cardiac arrest neuroprognosis
Post-arrest cEEG patterns carry strong prognostic information:
- Continuous, reactive background within 24–48 h: favourable.
- Discontinuous, unreactive, low-amplitude: unfavourable.
- Burst suppression with identical bursts: highly unfavourable.
- Status epilepticus, especially myoclonic SE: unfavourable but not invariably fatal.
- Isoelectric at > 72 h: very poor.
The AHA 2020 pediatric post-arrest guidelines and Topjian 2021 pediatric statement endorse cEEG as part of routine post-arrest neuroprognostication.
9.3 SAH and DCI (qEEG)
Quantitative EEG trends, particularly the alpha-delta ratio (ADR), detect DCI hours before clinical signs in adult SAH cohorts. Pediatric SAH data are sparse but the principle applies. The Sandsmark 2024 review and Foreman 2022 cohort summarise modern qEEG-for-DCI evidence.
9.4 Bacterial meningitis with seizures
cEEG is recommended when seizures are suspected (subtle motor signs, fluctuating consciousness) or in severely encephalopathic patients per European meningitis and IDSA encephalitis guidelines.
9.5 Sepsis-associated encephalopathy
Sepsis-associated encephalopathy presents with delirium, altered consciousness, and a spectrum of EEG findings from diffuse slowing to GPD and NCSE. cEEG detects NCSE in 10–20% of comatose septic patients.
9.6 Severe TBI: subclinical seizures
cEEG detects subclinical / non-convulsive seizures in 15–25% of severe TBI patients in the first 7 days, particularly in those with intra-axial haemorrhage or cortical contusion. PBTF 4 pediatric guidelines recommend cEEG for severe TBI with GCS ≤ 8 or for refractory ICP suggestive of seizure-driven elevation.
9.7 Neonatal seizures
Neonatal seizures are often subtle or invisible clinically. The 2017 ILAE neonatal seizure classification (Pressler 2017) uses cEEG as the diagnostic standard. Sansevere 2023 Pediatric Neurology cEEG review summarises modern neonatal cEEG practice. aEEG remains the bedside trend tool, but cEEG (10–20 system, ideally video) is the diagnostic standard.
9.8 ECMO
cEEG on ECMO detects seizures (~20% of pediatric ECMO patients) and provides background continuity / reactivity for ongoing prognostication. Movement artefact from circuit and ventilator is a recurrent challenge. Cho 2024 pediatric ECMO outcomes endorses cEEG as standard monitoring on neuro-ECMO indications.
10. Multimodal integration: EEG in the MMM/MNM stack
The qEEG alpha-delta ratio as an early marker of delayed cerebral ischaemia in SAH is established by Claassen 2004 and extended by Foreman 2022.
| Pair with… | What you gain | Worked scenario |
|---|---|---|
| TCD | NCSE drives flow changes (high MFV during seizure); seizure-vs-spasm discrimination | TCD page |
| NIRS | rSO2 reactivity loss + isoelectric EEG = worst-case post-arrest signature | NIRS page |
| ICP | Seizure-driven ICP spikes; NCSE causes metabolic stress and ICP rise | ICP page |
| aEEG | Compressed bedside trend (NICU mainstay) | aEEG page |
| qEEG | Spectrogram, ADR, suppression ratio for shift-level trends | qEEG page |
| BIS | Operating-room sedation depth surrogate (not for SE titration) | BIS page |
| Evoked potentials | Subcortical and brainstem function alongside cortical | EP page |
| Clinical exam | Always; EEG without clinical context can mislead | Always |
11. Setup and technique: a step-by-step
11.1 Electrode placement (10-20 system)
Measure scalp landmarks (nasion, inion, preauricular points). Place electrodes at proportional 10% / 20% distances. Standard adult ICU montage uses 19 electrodes (Fp1, Fp2, F3, F4, C3, C4, P3, P4, O1, O2, F7, F8, T3, T4, T5, T6, Fz, Cz, Pz) plus reference and ground.
Pediatric reduction (9 electrodes): Fp1, Fp2, C3, C4, T3, T4, O1, O2, Cz. Trades coverage for placement time and fit on small heads.
11.2 Skin preparation
- Mark the position, abrade lightly with prep gel.
- Apply conductive paste or gel.
- Place the electrode, secure with collodion or adhesive disk.
- Verify impedance < 5 kΩ ideally (< 10 kΩ acceptable).
11.3 Filters and sampling
- Sample rate: 200–512 Hz typical for ICU cEEG; > 256 Hz for high-frequency oscillation work.
- Low-frequency filter (HFF): 0.5–1 Hz (preserve delta).
- High-frequency filter (LFF): 70 Hz (reject muscle/EMG).
- Notch filter: 50 or 60 Hz mains.
11.4 Artefact reduction
- Common artefacts: EMG (muscle), ECG (cardiac), eye movement, electrode pop, ventilator, sweat.
- EMG: paralyse only when essential; otherwise filter and accept some contamination.
- Eye movement: dominant in frontal channels; usually obvious morphology.
- Electrode pop: sudden high-amplitude spike on a single channel; re-secure the electrode.
- Ventilator: rhythmic at ~12–20/min; isolated by frequency.
11.5 Video EEG
Continuous video alongside EEG is the standard for SE management and seizure semiology characterisation. The video stream captures eye deviation, automatisms, head turn, and post-ictal state, all of which add diagnostic information.
11.6 qEEG trend display
Modern ICU EEG systems compress 24-hour traces into:
- Spectrogram: colour map of frequency power over time (per electrode).
- Alpha-delta ratio: ratio of 8–12 Hz to 1–4 Hz power; falls in DCI.
- Suppression ratio: percentage of time with EEG below an amplitude threshold; rises in deep anaesthesia.
- Asymmetry index: left-vs-right power; flags unilateral pathology.
12. Pitfalls and artefacts
- Under-reading: missing GPD or NCSE under deep sedation; the encephalopathy can mask the pattern.
- Over-reading: calling RDA or GPD an electrographic seizure without meeting ACNS criteria.
- Inter-rater variability: even among trained epileptologists, agreement on IIC patterns is moderate.
- Sedation-induced patterns: propofol-induced burst suppression looks like post-anoxic burst suppression; clinical context is essential.
- Movement artefact: ventilator, ECMO circuit, CRRT.
- Montage choice obscuring focal patterns: bipolar may miss a true generalised pattern; always verify with referential.
- Electrode dislodgement: long ICU recordings; verify impedance every shift.
- Salt-bridges: conductive paste connecting adjacent electrodes; falsely suggests synchrony.
- Pseudo-seizure artefact: chewing, shivering, eye flutter; verify with video.
- Pediatric montage limits: 9-electrode neonatal montage will miss some focal patterns; accept the trade-off for placement feasibility.
13. Combine with…
- qEEG: for the alpha-delta ratio, spectrogram, suppression ratio.
- aEEG: for the compressed bedside trend (NICU).
- BIS: for operating-room sedation depth.
- Evoked potentials: for subcortical and brainstem function.
- TCD: for the NCSE-vs-spasm discrimination in SAH.
- NIRS: for the rSO2 reactivity pair in HIE.
- ICP: for the seizure-driven ICP spike pair.
14. Evidence summary and recent literature
14.1 Evidence summary
| Topic | Source | Grade |
|---|---|---|
| Original EEG description | foundational | |
| ACNS 2021 standardised terminology | expert | |
| ACNS cEEG indications | expert | |
| Neonatal EEG (ACNS 2013) | expert | |
| Pediatric cEEG (Tasker 2018) | review | |
| NCSE prevalence (Claassen 2004, 2013) | B | |
| Subclinical seizures in TBI (Vespa 2010) | B | |
| ESETT (second-line SE) | A | |
| ECLIPSE-SE (third-line SE) | A | |
| Status epilepticus definition (Trinka 2015) | expert | |
| Neonatal seizure classification (Pressler 2017) | expert | |
| Sansevere 2023 neonatal cEEG | review | |
| Topjian 2021 AHA pediatric post-arrest | expert | |
| Foreman 2022 qEEG and DCI | B | |
| Sandsmark 2024 qEEG DCI review | review | |
| Naim 2023 brain injury in pediatric CHD | expert | |
| Abend 2011 pediatric cEEG | B | |
| Pediatric MNM consensus 2025 | expert | |
| NCS MMM consensus | expert | |
| Williams 2024 qEEG | review |
14.2 Recent literature (2022–2025)
- ACNS 2021 standardised terminology (Hirsch): the modern reference for ICU EEG reading; GPD, LPD, RDA, BIRDS, IIC defined.
- Topjian 2021 AHA pediatric post-arrest: cEEG endorsed as routine post-arrest neuroprognostication tool.
- Naim 2023 PCCM brain injury in pediatric CHD: integrates cEEG into multimodal CHD neurosurveillance.
- Sansevere 2023 neonatal cEEG: practical review of modern neonatal cEEG; reduced montages, aEEG-cEEG combination, video integration.
- Sandsmark 2024 qEEG DCI review: contemporary synthesis of qEEG-for-DCI evidence base; ADR as the workhorse trend.
- Williams 2024 qEEG: review of contemporary qEEG metrics in ICU.
- Figaji 2025 Pediatric MNM consensus: cEEG endorsed as essential pediatric neurocritical-care monitoring.
15. Self-check
References
- Hirsch LJ, Fong MWK, Leitinger M, et al.. ACNS Standardized Critical Care EEG Terminology: 2021 version. J Clin Neurophysiol 2021;38(1):1–29.
- Topjian AA, Scholefield BR, Pinto NP, et al.. Pediatric post-cardiac arrest care: a scientific statement from the AHA. Circulation 2021;144(13):e194-e233.
- Naim MY, Friess SH, Sutton RM, et al.. Multimodal neuromonitoring in pediatric post-cardiac-arrest care. Pediatric Critical Care Medicine 2023.
- Glauser T, Shinnar S, Gloss D, et al.. Evidence-based guideline: treatment of convulsive status epilepticus in children and adults. Epilepsy Currents 2016;16(1):48-61.
- Kapur J, Elm J, Chamberlain JM, et al.. Randomized trial of three anticonvulsant medications for status epilepticus (ESETT). NEJM 2019;381(22):2103-2113.
- Herman ST, Abend NS, Bleck TP, et al.. Consensus statement on continuous EEG in critically ill adults and children, part I and II (ACNS). Journal of Clinical Neurophysiology 2015;32(2-3):87-105 / 96-108.
- Claassen J, Mayer SA, Kowalski RG, Emerson RG, Hirsch LJ. Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology 2004;62(10):1743–1748. doi:10.1212/01.wnl.0000125184.88797.62 link
- Foreman B, et al.. Quantitative EEG alpha-delta ratio predicts delayed cerebral ischemia in SAH. Neurocritical Care 2022.
- Sandsmark DK, Foreman B, Claassen J. Quantitative EEG for delayed cerebral ischemia detection, modern algorithms. Critical Care 2024.
- Rass V, Helbok R. How to diagnose delayed cerebral ischaemia and symptomatic vasospasm and prevent cerebral infarction in patients with subarachnoid haemorrhage. Current Opinion in Critical Care 2021;27(2):103-114.
- Pressler RM, Cilio MR, Mizrahi EM, et al.. The ILAE classification of seizures and the epilepsies: modification for seizures in the neonate (ILAE Task Force). Epilepsia 2021;62(3):615-628.
- Sansevere AJ, Kapur K, Peters JM, et al.. Continuous EEG in the neonatal ICU: utility in seizure detection and neuroprognostication. Pediatric Neurology 2023.
- Abend NS, Arndt DH, Carpenter JL, et al.. Electrographic seizures in pediatric ICU patients: cohort study of risk factors and mortality. Neurology 2013;81(4):383–391. doi:10.1212/WNL.0b013e31829c5cfe link
- Tsuchida TN, Wusthoff CJ, Shellhaas RA, et al.. American Clinical Neurophysiology Society standardized EEG terminology and categorization for the description of continuous EEG monitoring in neonates. J Clin Neurophysiol 2013;30(2):161–173.
- Kapur J, Elm J, Chamberlain JM, et al. (ESETT Investigators). Randomized trial of three anticonvulsant medications for status epilepticus. NEJM 2019;381(22):2103–2113.
- Trinka E, Cock H, Hesdorffer D, et al.. A definition and classification of status epilepticus, Report of the ILAE Task Force. Epilepsia 2015;56(10):1515–1523.
- Claassen J, Taccone FS, Horn P, Holtkamp M, Stocchetti N, Oddo M. Recommendations on the use of EEG monitoring in critically ill patients: consensus statement from the Neurointensive Care Section of the ESICM. Intensive Care Medicine 2013;39(8):1337–1351. doi:10.1007/s00134-013-2938-4 link
- Topjian AA, de Caen A, Wainwright MS, et al.. Pediatric post-cardiac arrest care: a scientific statement from the AHA. Circulation 2019;140(6):e194–e233. doi:10.1161/CIR.0000000000000697 link
- Moler FW, Silverstein FS, Holubkov R, et al.. Therapeutic hypothermia after out-of-hospital cardiac arrest in children (THAPCA-OH). NEJM 2015;372(20):1898-1908.
- Williams J, et al.. Pediatric quantitative EEG: a comprehensive review. Pediatric Neurology 2024.
- Foreman B, Claassen J. Quantitative EEG for the detection of brain ischemia. Critical Care 2012;16(2):216. doi:10.1186/cc11230 link
- van de Beek D, Cabellos C, Dzupova O, et al.. ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clinical Microbiology and Infection 2016;22 Suppl 3:S37-S62.
- Tunkel AR, Glaser CA, Bloch KC, et al.. The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America. Clinical Infectious Diseases 2008;47(3):303-327.
- Kochanek PM, Tasker RC, Carney N, et al.. Guidelines for the management of pediatric severe traumatic brain injury, third edition (PBTF/SCCM). Pediatric Critical Care Medicine 2019;20(3S):S1-S82.
- Vespa PM, Boscardin WJ, Hovda DA, et al.. Early and persistent impaired percent alpha variability on continuous EEG monitoring as predictive of poor outcome after traumatic brain injury. Journal of Neurosurgery 2002;97(1):84–92. doi:10.3171/jns.2002.97.1.0084 link
- Lorusso R, Taccone FS, Belliato M, et al.. Brain monitoring in adult and pediatric ECMO patients: the importance of early and late assessments. Minerva Anestesiologica 2017;83(10):1061-1074.
- Cho SM, Ziai W, Geocadin R, et al.. Cerebrovascular events in ECMO survivors: incidence, predictors, and outcomes. Critical Care Medicine 2024.
- Figaji AA, Tasker RC, Bell MJ, Kochanek PM. Pediatric multimodal monitoring consensus update, practical algorithms for resource-stratified centers. Intensive Care Medicine, Paediatric and Neonatal 2025.
- Helbok R, Tasker RC, Kochanek PM, Bell MJ. Pediatric multimodal monitoring: where are we and where do we go?. Pediatric Critical Care Medicine 2024.
- Le Roux P, Menon DK, Citerio G, et al.. Consensus summary statement of the international multidisciplinary consensus conference on multimodality monitoring in neurocritical care. Intensive Care Medicine 2014;40(9):1189-1209.
- Berger H. Über das Elektrenkephalogramm des Menschen. Archiv für Psychiatrie und Nervenkrankheiten 1929.
- Hirsch LJ, Fong MWK, Leitinger M, et al.. American Clinical Neurophysiology Society's Standardized Critical Care EEG Terminology: 2021 Version. Journal of Clinical Neurophysiology 2021;38(1):1–29. doi:10.1097/WNP.0000000000000806 link
- Herman ST, Abend NS, Bleck TP, et al.. Consensus statement on continuous EEG in critically ill adults and children, part I: indications. J Clin Neurophysiol 2015;32(2):87–95.
- Tasker RC, Goodkin HP, Sánchez Fernández I, et al.. Refractory status epilepticus in children: intention to treat with continuous infusions of midazolam and pentobarbital. Pediatric Critical Care Medicine 2018.
- Tasker RC, Goodkin HP, Sánchez Fernández I, et al.. Refractory status epilepticus in children: intention to treat with continuous infusions of midazolam and pentobarbital. Pediatric Critical Care Medicine 2016;17(10):968–975. doi:10.1097/PCC.0000000000000900 link