Breach rhythm-induced asymmetric post-arousal hypersynchrony mimicking ictal EEG in coma

In comatose or sedated ICU patients, stimulation-induced rhythmic delta waves with apparent evolution, and even benzodiazepine responsiveness, may represent normal arousal phenomena amplified by a breach rhythm rather than ictal activity. <b>Significance:</b> As stimulus-induced rhythmic, periodic, or ictal discharges (SIRPIDs) strictly describe EEG morphology and evolution without reference to the cause, normal arousals/awakenings and their variations must be recognized in comatose patients. Due to the ambiguity of the term "ictal" and its clinical implications, "ictal" could be replaced with "intermittent": Stimulus-Induced Rhythmic or Periodic Intermittent Discharges.