Point-of-Care EEG in Patients with Sepsis: Unveiling the Prevalence of Seizures and Highly Epileptiform Patterns and Their Impact on Clinical Management and Escalation of Care
Abstract number :
3.12
Submission category :
3. Neurophysiology / 3B. ICU EEG
Year :
2023
Submission ID :
1115
Source :
www.aesnet.org
Presentation date :
12/4/2023 12:00:00 AM
Published date :
Authors :
Presenting Author: Ashwaan Uddin, MD – HealthONE Swedish Medical Center
Kapil Gururangan, MD – Epilepsy Fellow, Department of Neurology, David Geffen School of Medicine at UCLA; Richard Kozak, MD – Department of Emergency Medicine – Providence Mission Medical Center; Matthew Kaplan, MD – Department of Emergency Medicine – Providence Mission Medical Center; Parshaw Dorriz, MD – Department of Neurology – Providence Mission Medical Center
Rationale: Non-convulsive seizures often go undetected in patients with sepsis due to inadequate access to EEG monitoring or delayed recognition of subclinical seizures as a potential neurological complication of systemic illness. We aim to describe the prevalence of seizures and highly epileptiform patterns (HEP) and their impact on management among patients with sepsis who underwent point-of-care EEG (pocEEG) monitoring at a community hospital.
Methods: We retrospectively identified patients who underwent pocEEG monitoring at a community hospital, over a one-year period, with a diagnosis of active infection or sepsis (whether in emergency department, intensive care unit, or general floor settings). We extracted clinical data on infection diagnosis, indication for pocEEG monitoring, pocEEG findings (classified as seizure, HEP, or slowing/normal activity), treatment with anti-seizure medications (ASM), and intubation status during pocEEG monitoring. We reviewed each patient’s hospital course around the time of pocEEG monitoring to determine the impact of pocEEG on ASM treatment.
Results: At our community hospital, 44 patients (mean age 64.2±20.5 years, 40.9% female) were diagnosed with active infection or sepsis: pneumonia in 20 (45.5%), urinary tract infection in 11 (25.0%), meningitis in 4 (9.1%), and other infections (osteomyelitis, pyelonephritis, cellulitis, H. pylori) in 9 (20.5%). The indication for pocEEG monitoring was unexplained or persistent encephalopathy in 39 patients (88.6%) and 16 patients (36.3%) were intubated during pocEEG monitoring. pocEEG revealed seizures in 3 patients (6.8%), HEP in 9 patients (20.4%), and slowing/normal activity in 32 patients (72.7%). One patient was found to be in focal status epilepticus. Based on physician evaluation of the patient’s hospital course, pocEEG was felt to directly impact ASM treatment (e.g., avoiding inappropriate escalation or guiding appropriate escalation) in 65.9% of cases. Patients with slow/normal activity avoided treatment escalation more often than patients with seizures/HEP (59.4% vs. 16.7%, p=0.02) and patients with seizures/HEP experienced treatment escalation more often than patients with slow/normal activity (33.3% vs. 12.5%, p=0.18).
Conclusions: Encephalopathic patients with sepsis or active infection who underwent pocEEG monitoring were found to have seizures or highly epileptiform activity in 27% of cases. PocEEG impacted management by guiding appropriate ASM treatment, especially by avoiding inappropriate treatment escalation in patients without epileptiform activity.
Funding: Study funded by Ceribell, Inc.
Neurophysiology