How do you approach ictal-interictal continuum in patients with presumed toxic/metabolic etiology?

This is a common conundrum in the EEG reading room. If during the routine EEG I get a sense that the GPDs are clearly state-dependent (i.e., more frequent in the alert state, taper off in the quiet state) and they have clear triphasic morphology, I may not do anything further aside from the recommended treatment of the underlying metabolic disturbance.

If I do not feel comfortable about those features during the routine EEG, the patient will often then be hooked up to cEEG for the accumulation of additional data. This will allow for the detection of subclinical seizures, for a better sense of the behavior of the GPDs over time, and potentially to determine response to treatment for presumed epileptic etiology, if one chooses to go down that...