Abstracts

This abstract has been invited to present during the Broadening Representation Inclusion and Diversity by Growing Equity (BRIDGE) poster session

Rationale: The Neurocritical Care Society guidelines state that continuous EEG (cEEG) monitoring should be started within an hour once a diagnosis of status epilepticus is considered. However, even hospitals with EEG technicians available 24 hours a day typically have 2.7- to 4.8-hour delays from the EEG order to the start of recording. Limited EEG technician availability will cause even longer delays. Rapid response EEG systems (rrEEG) are intended to reduce the delay to EEG recording; setup is faster than conventional cEEG and does not require an EEG technician. Our hospital uses Ceribell^® rrEEG. An initial interpretation of the rrEEG recording is provided within its first hour. If cEEG is not available, rrEEG is continued for a total of 3 to 6 hours, at which time a final rrEEG report is written. In this study we reviewed initial and final rrEEG reports to determine the utility of continuing rrEEG monitoring beyond the first hour. We also compared the final rrEEG report to the findings after 24 hours of cEEG to analyze strengths and weaknesses of rrEEG monitoring.

Methods: This is a retrospective chart review of the first 200 patients who had rrEEG studies at the Montefiore Medical Center with a preliminary report describing no more than 1 hour and a final report describing 3 to 6 hours of rrEEG. The rrEEG reports were reviewed for descriptions of seizures, periodic discharges, and sporadic epileptiform discharges. In patients who had at least 24 hours of traditional 21-lead cEEG monitoring starting within 24 hours of the rrEEG, the reports of the first 24 hours of cEEG were analyzed for the same findings.

Results: Sixteen of the 200 patients were reported to have definite seizures on rrEEG, and 4 patients had possible seizures. Of the 16 patients with definite seizures, the seizures were detected during the preliminary report in 11 and were not detected until the final report in 5. Fifty-nine patients had at least 24 hours of cEEG monitoring that started within 24 hours of the initiation of rrEEG. Compared to the patients without 24 hours of cEEG, these 59 patients were more likely to have seizures (17% vs. 4.3% of patients), periodic discharges (24% vs. 11%), and sporadic epileptiform discharges (36 % vs. 30%) on rrEEG. Of these 59 patients, 10 had seizures during the rrEEG and 8 of them were successfully treated prior to initiation of cEEG. There were 8 patients with seizures on cEEG whose rrEEG studies were read as having either no seizures or an unclear diagnosis. Five of these patients had seizures that could be identified by looking at the temporal chains alone. One patient had seizures that were in the parietal region and not identifiable using only the temporal chains. Two had myoclonic seizures that looked like generalized periodic discharges using the temporal chains and required video correlation to determine that they were seizures.

Conclusions: rrEEG monitoring, ideally for 3 to 6 hours if cEEG is not available earlier, allows for early recognition and treatment of seizures, but should not be used as an alternative to cEEG or as a screening tool to determine who should undergo cEEG.

Funding: None