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

Husain et al., JNNP 2002 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 Sensitivity (%)Specificity (%) Recent risk factors7528 Remote risk factors7558 Tonic-clonic activity5058 History of epilepsy1772 Ocular movement abnormalities 5086 Subtle motor activity7544

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