How do you approach management of an ICU patient with brief potentially ictal rhythmic discharges (BIRDs) on EEG?   

This is a very challenging question, and the clinical importance of BIRDs, besides being associated with an increased frequency of seizures (Yoo et al., PMID 24535702 ), is unclear. I am a neurointensivist, and in general, I do not escalate therapy for intermittent BIRDs unless we identify concomita...

BIRDs are ictal appearing rhythmic discharges that have been shown to correlate with increased seizure risk in critically ill (and non critically ill) patients, leading to worse clinical outcomes. They are focal or generalized rhythmic activity >4 Hz lasting ≥0.5 to <10 seconds, not consist...