Prevalence of Seizures and Highly Epileptiform Patterns Detected Using Point-of-Care Electroencephalography at a Community Hospital
Abstract number :
2.016
Submission category :
3. Neurophysiology / 3B. ICU EEG
Year :
2023
Submission ID :
926
Source :
www.aesnet.org
Presentation date :
12/3/2023 12:00:00 AM
Published date :
Authors :
First Author: Matthew Kaplan, MD – Providence Mission Medical Center
Presenting Author: Kapil Gururangan, MD – University of California, Los Angeles
Kapil Gururangan, MD – Epilepsy Fellow, Department of Neurology, David Geffen School of Medicine at UCLA; Parshaw Dorriz, MD – Adjunct Assistant Professor of Clinical Neurology, Department of Neurology, Providence Mission Medical Center; Richard Kozak, MD – Emergency Department Assistant Medical Director, Department of Emergency Medicine, Providence Mission Medical Center
Rationale: Non-convulsive seizures and status epilepticus (NCS/NCSE) may go undetected because of the scarcity of conventional EEG monitoring infrastructure. This likely leads to an under-appreciation of the true prevalence of NCS/NCSE among patients treated at community hospitals, who might end up being transferred solely to obtain EEG monitoring. Point-of-care EEG (pocEEG) could bridge this gap by expanding access to EEG. In this study, we describe our institutional experience of pocEEG and the prevalence of seizures and highly epileptiform patterns (HEP) observed in our cohort.
Methods: We retrospectively identified patients who underwent pocEEG monitoring in our community hospital during a one-year period (1/1/2020 through 12/31/2020), including patients who had their first episode of pocEEG monitoring in the emergency department (ED), intensive care unit (ICU), or general medical-surgical floor units. We categorized pocEEG findings as NCS/NCSE, HEP (most rhythmic and periodic patterns along the ictal-interictal continuum), slowing (including generalized rhythmic delta activity and burst-suppression), or normal activity. Statistical significance was assessed using chi-square tests.
Results: At our community hospital, 319 patients (mean age 61.4±21.5 years, 43.3% female) underwent their first episode of pocEEG monitoring in the ED (157, 49.2%), ICU (92, 28.8%), or floor (70, 21.9%), with 57.4% of pocEEG studies performed after-hours (weekdays 5p-9a and all-day weekends). pocEEG monitoring was performed due to unexplained encephalopathy in 63.9%, preceding clinical seizure without return to baseline in 27.6%, and cardiac arrest in 8.2%. pocEEG revealed NCS/NCSE in 34 (10.7%; 18 with NCSE), HEP in 66 (20.7%), slowing in 157 (49.2%), and normal activity in 62 (19.4%). Ictal activity was detected at the start of the recording in 10 patients (NCS in 2, NCSE in 8). We observed a significant association between hospital setting (ED, ICU, or floor) and pocEEG finding (p=0.03), with a greater percentage of studies showing NCS/NCSE in the ED (14.0%) than the ICU and floor (6.5% and 8.6%), HEP in the ED and ICU (21.7% and 22.8%) than the floor (15.7%), slowing in the ICU (59.8%) than the ED and floor (43.9% and 41.7%), and normal activity in the ED and floor (20.4% and 28.6%) than the ICU (10.9%).
Conclusions: At our community hospital, pocEEG monitoring revealed seizures and highly epileptiform patterns in nearly one-third of critically ill patients with suspected NCS, as well as expanding access to EEG monitoring with roughly half of pocEEG studies being done after-hours when conventional EEG would otherwise have been unavailable. To meet the rising awareness of NCS/NCSE as a neurological emergency, pocEEG tools could help expand access to EEG monitoring, guide urgent triage and treatment decisions, and avert unnecessary inter-hospital transfers.
Funding: Study funded by Ceribell, Inc.
Neurophysiology