How to carry out and interpret EEG recordings in COVID-19 patients in ICU?

• Published in: Clinical neurophysiology 2020-08, Vol.131 (8), p.2023-2031
• Main Authors: Gélisse, Philippe, Rossetti, Andrea O., Genton, Pierre, Crespel, Arielle, Kaplan, Peter W.
• Format: Article
• Language: English
• Subjects: Brain Diseases - diagnosis; Brain Diseases - etiology; Brain Diseases - physiopathology; Coma; Coronavirus Infections - complications; Coronavirus Infections - diagnosis; Coronavirus Infections - therapy; COVID-19; Critical Care - methods; Critical Care - standards; EEG; Electroencephalography - instrumentation; Electroencephalography - methods; Electroencephalography - standards; Humans; ICU; Pandemics; Patient Positioning - methods; Pneumonia, Viral - complications; Pneumonia, Viral - diagnosis; Pneumonia, Viral - therapy; Practice Guidelines as Topic; Prone position
• ISSN: 1388-2457; 1872-8952
• DOI: 10.1016/j.clinph.2020.05.006

•Reduced montages with subdermal single-use EEG needle electrodes may be used in comatose COVID-19 patients.•Full 10-20 EEG placement with an ECG derivation remains the standard.•Note if the patient undergoes prone positioning, note the patient and head position, along with patterns of breathing. There are questions and challenges regarding neurologic complications in COVID-19 patients. EEG is a safe and efficient tool for the evaluation of brain function, even in the context of COVID-19. However, EEG technologists should not be put in danger if obtaining an EEG does not significantly advance diagnosis or change management in the patient. Not every neurologic problem stems from a primary brain injury: confusion, impaired consciousness that evolves to stupor and coma, and headaches are frequent in hypercapnic/hypoxic encephalopathies. In patients with chronic pulmonary disorders, acute symptomatic seizures have been reported in acute respiratory failure in 6%. The clinician should be aware of the various EEG patterns in hypercapnic/hypoxic and anoxic (post-cardiac arrest syndrome) encephalopathies as well as encephalitides. In this emerging pandemic of infectious disease, reduced EEG montages using single-use subdermal EEG needle electrodes may be used in comatose patients. A full 10–20 EEG complement of electrodes with an ECG derivation remains the standard. Under COVID-19 conditions, an expedited study that adequately screens for generalized status epilepticus, most types of regional status epilepticus, encephalopathy or sleep may serve for most clinical questions, using simplified montages may limit the risk of infection to EEG technologists. We recommend noting whether the patient is undergoing or has been placed prone, as well as noting the body and head position during the EEG recording (supine versus prone) to avoid overinterpretation of respiratory, head movement, electrode, muscle or other artifacts. There is slight elevation of intracranial pressure in the prone position. In non-comatose patients, the hyperventilation procedure should be avoided. At present, non-specific EEG findings and abnormalities should not be considered as being specific for COVID-19 related encephalopathy.