When Respiratory Therapy Looks Like a Seizure on EEG

Alkawadri R. Respiratory therapy mimicking electrographic seizures. Acta Neurologica Belgica. 2023;123(5):1973–1974. PMID: 36115916.

EEG is exquisitely sensitive to cerebral voltage—but it is also sensitive to the physical world around the patient. Movement, muscle, pumps, ventilators, and therapeutic devices can all enter the recording. Some artifacts are obvious. Others acquire the rhythm, evolution, and visual authority of a seizure.

This report documents chest-vest respiratory therapy mimicking electrographic seizure activity. The figure tells the diagnostic story: a rhythmic pattern begins with therapy and ends when therapy stops. That temporal coupling, combined with the field distribution, morphology, clinical context, and absence of a convincing electroclinical correlate, helps separate an external mechanical source from cerebral ictal activity.

The lesson is not simply to “recognize artifact.” It is to test competing explanations. What changed in the room? Does the pattern respect neuroanatomy? Does it evolve in a physiologically plausible way? Is there a clinical correlate? Can the signal be reproduced or abolished when the suspected source changes?

Critical-care EEG often operates where false positives have consequences. A compelling waveform should therefore trigger both pattern recognition and source investigation. The best interpretation is the one that explains the signal, the patient, and the environment together.

Full article:

https://doi.org/10.1007/s13760-022-02088-8

PubMed:

https://pubmed.ncbi.nlm.nih.gov/36115916/

Figure caption: Rhythmic EEG artifact begins with chest-vest therapy and ends when therapy stops. Reused unmodified from the author’s accepted-manuscript figure under Springer Nature author-reuse terms: Alkawadri, Acta Neurologica Belgica. 2023;123(5):1973–1974.

Two stacked EEG traces show a rhythmic pattern appearing during chest-vest therapy and stopping abruptly when the therapy ends. — Rhythmic EEG artifact begins with chest-vest therapy and ends when therapy stops. Reused unmodified from the author’s accepted-manuscript figure under Springer Nature author-reuse terms: Alkawadri, *Acta Neurologica Belgica*. 2023;123(5):1973–1974. Read the full article.

Figure description: Two stacked EEG traces show the rhythmic pattern appearing across multiple channels when chest-vest therapy begins and stopping abruptly when therapy ends.