Abstracts

Policies of administration, availability, and utility of ordering emergency EEGs (e-EEGs) and emergency video-EEGs (e-video-EEGs) during non-business hours vary widely among different EEG laboratories¹. There are no data available to address this question in the pediatric population in a children[rsquo]s hospital setting.
We retrospectively analyzed the total number of non-business hours e-EEGs, and e-video-EEGs done in one year at our center. We defined non-business hours as after 5 pm every day, and on Saturday and Sunday. Only neurologists were allowed to approve performing these tests. A neurological consultation was not done in all cases before granting approval. Interpretation of the study by a neurologist was available immediately or within a few hours of performing the test.
As a university based free standing teaching children[rsquo]s hospital, the number of EEG studies performed in one year at our Neurophysiology laboratory was: 1212 routine EEGs, 387 24-hours ambulatory EEGs, 81 video-EEGs, and 141 long-term bedside EEGs. The number of emergency studies during the same period of time was 33 (1.8% of total studies done): 18 e-EEGs, 9 emergency long-term bedside EEGs (e-LT-B-EEGs), and 6 e-video-EEGs. The reasons for ordering the 18 e-EEGs included the evaluation of 1) non-convulsive status epilepticus (n=5), 2) paroxysmal movement (n= 3 ), 3) treatment response to anti-epileptic drugs (AEDs) (n= 4), 4) prolonged febrile/afebrile seizures (n=2 ), 5) brain death (n= 4). The 9 e-LT-B-EEGs were done to evaluate 1) frequently occurring paroxysmal events (n=1), 2) treatment response to AEDs (n=4), 3) non-convulsive status (n=3), 4) monitoring therapeutic burst suppression pattern (n=1). 5 of the 9 e-LT-B-EEGs were done after an abnormal e-EEG. The 6 e-video-EEGs were done to evaluate frequently occurring paroxysmal events. The events were diagnosed to be seizures (n=1), pseudo-seizures (n=2), and non-epileptic behaviors (n= 3). Overall, e-EEGs and e-video-EEGs were useful in decision-making in 31 out of 33 (94%) studies.
In our experience, e-EEGs and e-videoEEGs during non-business hours have a high yield of offering useful information. This may be related to the fact that all of the studies need approval by a neurologist. Appropriate strategies need to be developed to make this essential, albeit very expensive service available for patient care.

1) Quigg M, Shneker B, Domer P. Current practice in administration and clinical criteria of emergent EEG. J Cli Neurophysiol 2001; 18(2): 162-165.