STAT (Ememgent) EEGs

Nonconvulsive Status Epilepticus

Neurophysiologie Clinique 1998

• 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

STAT

• From Latin statim - immediately

Benbadis 2008

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

• Performed emergently• Interpreted emergently• Acted upon emergently

Khan et al., Clin Neurophysiol 2005

• 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

Praline et al. 2007

• 111 consecutive eEEGs• Change in treatment – 37.8%

• 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 factors 75 28

Remote risk factors 75 58

Tonic-clonic activity 50 58

History of epilepsy 17 72

Ocular movement abnormalities

50 86

Subtle motor activity 75 44

R. Khan, J Natl Med Assn, 2001

• 78 emergent EEGs– 8 NCSE

• Risk factors– History of epilepsy– Observed GTCS– Seizure-like motor activity

R. Khan et al, 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, 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

Patients with “seizure like” motor activity

• 10 – EEG slowing (nonspecific)• 1 - NCSE

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

Benbadis, Epilepsia, 2010

• 52 cEEG studies for “possible seizures”• 14 (27%) had epileptic seizures• 38 (73%) had non-epileptic events

– Tremor– Myoclonus– Slow semi-purposeful movements– Miscellaneous