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Rapid Diagnosis of Nonconvulsive Status Epilepticus Using Reduced-Lead Electroencephalography

INTRODUCTION: Electroencephalography (EEG) is indicated for diagnosing nonconvulsive status epilepticus (NCSE) in a patient who has altered level of consciousness after a motor seizure. A study in a neonatal population found 94% sensitivity and 78% specificity for detection of seizure using a single...

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Autores principales: Brenner, Jay M., Kent, Paul, Wojcik, Susan M., Grant, William
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Department of Emergency Medicine, University of California, Irvine School of Medicine 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4427223/
https://www.ncbi.nlm.nih.gov/pubmed/25987926
http://dx.doi.org/10.5811/westjem.2015.3.24137
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author Brenner, Jay M.
Kent, Paul
Wojcik, Susan M.
Grant, William
author_facet Brenner, Jay M.
Kent, Paul
Wojcik, Susan M.
Grant, William
author_sort Brenner, Jay M.
collection PubMed
description INTRODUCTION: Electroencephalography (EEG) is indicated for diagnosing nonconvulsive status epilepticus (NCSE) in a patient who has altered level of consciousness after a motor seizure. A study in a neonatal population found 94% sensitivity and 78% specificity for detection of seizure using a single-lead device. This study aims to show that a reduced montage EEG would detect 90% of seizures detected on standard EEG. METHODS: A portable Brainmaster EEG device was available in the emergency department (ED) at all times. Patients presenting to the ED with altered mental status and known history of seizure or a witnessed seizure having a standard EEG were eligible for this study. The emergency physician obtained informed consent from the legally authorized representative (LAR), while an ED technician attached the electrodes to the patient, and a research associate attached the electrodes to the wiring routing to the portable EEG module. A board-certified epileptologist interpreted the tracings via the Internet. Simultaneously, the emergency physician ordered a standard 23-lead EEG, which would be interpreted by the neurologist on call to read EEGs. We compared the epileptologist’s interpretation of the reduced montage EEG to the results of the 23-lead EEG, which was considered the gold standard for detecting seizures. RESULTS: Twelve of 12 patients or 100% had the same findings on reduced-montage EEG as standard EEG. One of 12 patients or 8% had nonconvulsive seizure activity. CONCLUSION: The results are consistent with prior studies which have shown that 8–48% of patients who have had a motor seizure continue to have nonconvulsive seizure activity on EEG. This study suggests that a bedside reduced-montage EEG can be used to make the diagnosis of NCSE in the ED. Further study will be conducted to see if this technology can be applied to the inpatient neurological intensive care unit setting.
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spelling pubmed-44272232015-05-18 Rapid Diagnosis of Nonconvulsive Status Epilepticus Using Reduced-Lead Electroencephalography Brenner, Jay M. Kent, Paul Wojcik, Susan M. Grant, William West J Emerg Med Technology in Emergency Medicine INTRODUCTION: Electroencephalography (EEG) is indicated for diagnosing nonconvulsive status epilepticus (NCSE) in a patient who has altered level of consciousness after a motor seizure. A study in a neonatal population found 94% sensitivity and 78% specificity for detection of seizure using a single-lead device. This study aims to show that a reduced montage EEG would detect 90% of seizures detected on standard EEG. METHODS: A portable Brainmaster EEG device was available in the emergency department (ED) at all times. Patients presenting to the ED with altered mental status and known history of seizure or a witnessed seizure having a standard EEG were eligible for this study. The emergency physician obtained informed consent from the legally authorized representative (LAR), while an ED technician attached the electrodes to the patient, and a research associate attached the electrodes to the wiring routing to the portable EEG module. A board-certified epileptologist interpreted the tracings via the Internet. Simultaneously, the emergency physician ordered a standard 23-lead EEG, which would be interpreted by the neurologist on call to read EEGs. We compared the epileptologist’s interpretation of the reduced montage EEG to the results of the 23-lead EEG, which was considered the gold standard for detecting seizures. RESULTS: Twelve of 12 patients or 100% had the same findings on reduced-montage EEG as standard EEG. One of 12 patients or 8% had nonconvulsive seizure activity. CONCLUSION: The results are consistent with prior studies which have shown that 8–48% of patients who have had a motor seizure continue to have nonconvulsive seizure activity on EEG. This study suggests that a bedside reduced-montage EEG can be used to make the diagnosis of NCSE in the ED. Further study will be conducted to see if this technology can be applied to the inpatient neurological intensive care unit setting. Department of Emergency Medicine, University of California, Irvine School of Medicine 2015-05 2015-04-06 /pmc/articles/PMC4427223/ /pubmed/25987926 http://dx.doi.org/10.5811/westjem.2015.3.24137 Text en Copyright © 2015 the authors. http://creativecommons.org/licenses/by/4.0 This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License. See: http://creativecommons.org/licenses/by/4.0/.
spellingShingle Technology in Emergency Medicine
Brenner, Jay M.
Kent, Paul
Wojcik, Susan M.
Grant, William
Rapid Diagnosis of Nonconvulsive Status Epilepticus Using Reduced-Lead Electroencephalography
title Rapid Diagnosis of Nonconvulsive Status Epilepticus Using Reduced-Lead Electroencephalography
title_full Rapid Diagnosis of Nonconvulsive Status Epilepticus Using Reduced-Lead Electroencephalography
title_fullStr Rapid Diagnosis of Nonconvulsive Status Epilepticus Using Reduced-Lead Electroencephalography
title_full_unstemmed Rapid Diagnosis of Nonconvulsive Status Epilepticus Using Reduced-Lead Electroencephalography
title_short Rapid Diagnosis of Nonconvulsive Status Epilepticus Using Reduced-Lead Electroencephalography
title_sort rapid diagnosis of nonconvulsive status epilepticus using reduced-lead electroencephalography
topic Technology in Emergency Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4427223/
https://www.ncbi.nlm.nih.gov/pubmed/25987926
http://dx.doi.org/10.5811/westjem.2015.3.24137
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