Understanding Nonconvulsive Status Epilepticus: Urgent Role of Emergent EEGs in Diagnosis and Treatment
Nonconvulsive status epilepticus (NCSE) is a life-threatening condition requiring immediate intervention to prevent serious complications. This emergency situation often faces challenges such as poor time management, staffing issues, and increased stress among medical personnel. Stat EEGs play a critical role in the rapid diagnosis and management of NCSE, with studies showing a 93% utility in epilepsy-related indications. Proper utilization of emergent EEGs can facilitate timely treatment decisions, proving essential for patient outcomes in acute care settings.
Understanding Nonconvulsive Status Epilepticus: Urgent Role of Emergent EEGs in Diagnosis and Treatment
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STAT (Ememgent) EEGs Nonconvulsive Status Epilepticus
Emergency – pathological condition which is life threatening or which can lead to organ failure requiring prompt treatment in order to avoid severe worsening and/or severe sequels Neurophysiologie Clinique 1998
STAT • From Latin statim- immediately
Problems • Poor use of time and resources • Detriment of patients who really need stat procedures • Increased turnaround time of non-STAT procedures • Staffing difficulties • Increasing use of overtime • Frustration and strain on staff and physicians • STAT EEG is not like STAT EKG Benbadis 2008
Performed emergently • Interpreted emergently • Acted upon emergently
256 emegent EEGs (total 2798 EEGs) • Useful helped in diagnosis, therapy or exclusion of specific condition • Corroborative • Not useful Khan et al., Clin Neurophysiol 2005
Epilepsy related indictions(status epilepticus and followup, recurrent seizures, nonconvulsive status) – 93% useful • Other conditions – 52.6% useful Khan et al., Clin Neurophysiol., 2005
111 consecutive eEEGs • Change in treatment – 37.8% Praline et al. 2007
32 emergent pediatric EEGs (1.8 % of total) • Useful in decision making 30/32 (94 %) • Neurologist approved all of studies Kothare et al. J Child Neurol 2005
Comparison of NCSE (12) and non-NCSE (36) • Duration of symptoms • Remote risk factors* • Recent risk factors • Tonic-clonic activity in current episode • History of epilepsy • Mental state/Glasgow coma scale* • Ocular movement abnormalities* • Subtle motor abnormalities Husain et al., JNNP 2002
Remote risk factors • Previous stroke • Previous neurosurgery • Tumor • Dementia • Meningitis Husain et al. JNNP 2002
Eye movement abnormalities • Nystagmoid eye jerks • Hippus • Repeated blinking • Persistent eye deviation Husain et al., JNNP 2002
78 emergent EEGs • 8 NCSE • Risk factors • History of epilepsy • Observed GTCS • Seizure-like motor activity R. Khan, J Natl Med Assn, 2001
All patients (8) with NCSE had at least one risk factor • 35 patients had at least one risk factor • 43 patients had no risk factors – none had NCSE R. Khan et al, J Natl Med Assn,2001
Seizure like motor activity • Myoclonus • Nystagmoid eye movements • Eyelid fluttering • Conjugate eye deviations • Focal or multifocal twitching of the extremities R. Khan, J Natl Med Assn, 2001
Patients with “seizure like” motor activity • 10 – EEG slowing (nonspecific) • 1 - NCSE R. Khan, J. Natl Med Assn
HUP study • 152 patients to characterize specific events • Seizure incidence 31% • 363 patients with altered mental status • Seizure incidence 29%
Majority of movements in ICU are non-epileptic • Facial and eye twitching high correlate with seizure activity
52 cEEG studies for “possible seizures” • 14 (27%) had epileptic seizures • 38 (73%) had non-epileptic events • Tremor • Myoclonus • Slow semi-purposeful movements • Miscellaneous Benbadis, Epilepsia, 2010
