Abstracts

There are 14 million yearly visits to the Emergency Department (ED) by patients with potential or undiagnosed seizure disorder. Due to the cost and expertise required to test and read an electroencephalogram (EEG), most hospitals cannot provide EDs with real-time EEG coverage. Thus, patients are often admitted to the hospital for work-up with their potential seizure disorder undiagnosed and untreated for days. A portable, wireless multi-channel EEG device (Crystal Monitor) was developed to provide a screening EEG in the ED. The Crystal Monitor utilizes a four-channel montage to minimize set-up time. The data is digitized allowing a neurologist with internet access to interpret the EEG and provide immediate feedback. The objective was to evaluate the feasibility of a wireless, four-channel screening system on selected patients in the ED., We conducted a prospective observational study on patients presenting to Troy Beaumont[apos]s ED. Adult patients (age [gt] 18 years) with a preliminary diagnosis of syncope, potential partial-complex or generalized seizure disorder, head injury with prolonged symptoms or acute undiagnosed altered mental status were eligible for enrollment. Patients with a confirmed non-neurologic diagnosis for their presenting complaint were excluded. Eligible patients were then asked to complete an informed consent and had a four-channel EEG performed by a trained ED research assistant with no prior EEG experience. The EEG data was then encrypted and transmitted by the internet to the study neurologist. ED physicians were blinded to the result; therefore, treatment plan was not altered. Primary outcome measures were EEG quality and EEG diagnosis. EEG quality was evaluated using the following criteria: 1=poor quality, unusable, 2=fair quality, acceptable, 3= good quality, acceptable 4=excellent quality, acceptable., A total of 101 patients have been enrolled in the trial with 39.6% female and a mean age of 59.5 years. The indication for a screening EEG was: 1) witnessed or suspected seizure disorder (71); 2) syncope (20); 3) dizziness, confusion or other altered mental status (7); and 4) head injury with prolonged symptoms (3). The EEG quality was acceptable in 91 of the performed EEGs. The EEG interpretation for all acceptable EEGs was: 1) normal (50) with 2 of those patients diagnosed as having a pseudoseizure, 2) generalized slowing (34) with 11 of those patients being post-ictal patients, and 3) subclinical epileptogenic foci (7)., Four-channel wireless EEG used in the ED is feasible, provides good quality screening EEGs and revealed abnormal EEG activity in a significant number of patients., (Supported by National Institute of Health, Small Business Innovative Research initiative, grant # 2R44NS042977-04.)