Rapid diagnosis of nonconvulsive status epilepticus using reduced-lead electroencephalography

• Published in: The western journal of emergency medicine 2015-05, Vol.16 (3), p.442-446
• Main Authors: Brenner, Jay M, Kent, Paul, Wojcik, Susan M, Grant, William
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Electroencephalography - instrumentation; Electroencephalography - methods; Emergency Service, Hospital; Feasibility Studies; Female; Humans; Intensive Care Units; Male; Middle Aged; Monitoring, Physiologic - instrumentation; Monitoring, Physiologic - methods; Point-of-Care Systems; Reproducibility of Results; Sensitivity and Specificity; Status Epilepticus - diagnosis; Status Epilepticus - physiopathology; Technology in Emergency Medicine
• ISSN: 1936-900X; 1936-9018
• DOI: 10.5811/westjem.2015.3.24137

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. 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. 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. 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.