Abstracts

Rationale: Access to electroencephalogram (EEG), especially long-term EEG, is limited, particularly at smaller hospitals. Reduced-montage point-of-care EEG (rmEEG) is an additional tool for EEG monitoring that can fill this gap in EEG access. While rmEEG’s role in seizure diagnosis is well established, its role in seizure management is less developed to date. We reviewed the use and impact of rmEEG on patient care in a community teaching hospital with limited access to routine full-montage EEG (fmEEG) and no access to long-term fmEEG to assess the effectiveness of rmEEG in the management of seizures and status epilepticus.

Methods: This is a retrospective descriptive study of Ceribell^® rmEEG use at Garden City Hospital from May 2021 until April 2023. The indication for monitoring was to assess for nonconvulsive status epilepticus (NCSE) in patients with altered mental status (AMS), diagnose seizure-like episodes, manage seizures and convulsive status epilepticus, and manage cardiopulmonary arrest (CPA). rmEEG results were reviewed and its impact on patient care was assessed by whether it reduced concern for seizures and prevented treatment escalation or facilitated ASM management in those with seizures. Finally, patient outcomes and rmEEG's value in avoiding patient transfer to institutions with long-term fmEEG monitoring was assessed.

Results: rmEEG monitoring was used in 86 patient admissions during this period (mean age 63.7 years, range 19 to 89 years, 52.3% female and 47.7% male). The mean rmEEG monitoring duration was 1365 minutes (22.7 hours). Ten (11.6%) patients had clinical convulsive status epilepticus (CSE) without seizures detected on subsequent EEG monitoring. rmEEG detected epileptiform activity in two (5.6%), seizures in three (8.3%), and status epilepticus in six (16.7%) of the 36 patients with AMS. It confirmed seizures in two of the nine patients (22.2%) with seizure-like activity. Status epilepticus was detected in two of the 24 patients (8.3%) being managed for convulsive seizures and four of the 17 patients (23.5%) being managed after CPA. In total, CSE was diagnosed in 16 (18.6%), NCSE in seven (8.1%), and both in one (1.2%) patient. rmEEG reduced concern for seizures and prevented treatment escalation in 54 (62.8%) patients and facilitated ASM adjustment in 32 (37.2%) of patients being managed for seizures. Of the 24 (27.9%) patients diagnosed with status epilepticus, both convulsive and NCSE, it resolved in 18 (75%), care was withdrawn by family in five (20.8%), three (60%) of whom had CPA, and status did not resolve in one (4.2%) who was the only patient transferred for long-term fmEEG monitoring.

Conclusions: Our review demonstrates that rmEEG is a valuable tool for community hospitals without long-term fmEEG, and it can be successfully used to manage status epilepticus and avoid patient transfers. Future prospective studies can be designed to compare the effectiveness of managing status epilepticus with rmEEG and long-term fmEEG monitoring.

Funding: None.