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In Reply We appreciate Dr Sethi’s interest in our work. Dr Sethi’s concerns have already been addressed at length in the original article.1 We would like to reemphasize the following points. In neonates with brain injury, brief potentially ictal rhythmic discharges (B[I]RDs) are independently associated with poor outcome to the same extent as full-length seizures.2,3 We found a similar trend toward worse outcome in patients with B(I)RDs, although this did not reach statistical significance, probably owing to the small size of our cohort. Many careful investigations have documented that nonconvulsive seizures/status epilepticus are responsible for acute adverse metabolic and hemodynamic derangements4 and are independently associated with worse short- and long-term outcomes.5,6 Because most (>90%) patients with B(I)RDs will also exhibit full-length seizures, for which treatment is accepted, the decision to treat B(I)RDs or not is moot—they need treatment for their seizures whether you have already documented their existence or not.
Gaspard N, Yoo JY, Hirsch LJ. Brief Rhythmic Discharges in Electroencephalography on an Interictal to Ictal Continuum—Reply. JAMA Neurol. 2014;71(9):1193-1194. doi:10.1001/jamaneurol.2014.1865