Skip to main content

Advertisement

SpringerLink
Log in

Diagnostic Reliability of Headset-Type Continuous Video EEG Monitoring for Detection of ICU Patterns and NCSE in Patients with Altered Mental Status with Unknown Etiology

  • Original Work
  • Published:
Neurocritical Care Aims and scope Submit manuscript

Abstract

Background/Objective

Simplified continuous electroencephalogram (cEEG) monitoring has shown improvement in detecting seizures; however, it is insufficient in detecting abnormal EEG patterns, such as periodic discharges (PDs), rhythmic delta activity (RDA), spikes and waves (SW), and continuous slow wave (CS), as well as nonconvulsive status epilepticus (NCSE). Headset-type continuous video EEG monitoring (HS-cv EEG monitoring; AE-120A EEG Headset™, Nihon Kohden, Tokyo, Japan) is a recently developed easy-to-use technology with eight channels. However, its ability to detect abnormal EEG patterns with raw EEG data has not been comprehensively evaluated. We aimed to examine the diagnostic accuracy of HS-cv EEG monitoring in detecting abnormal EEG patterns and NCSE in patients with altered mental status (AMS) with unknown etiology. We also evaluated the time required to initiate HS-cv EEG monitoring in these patients.

Methods

We prospectively observed and retrospectively examined patients who were admitted with AMS between January and December 2017 at the neurointensive care unit at Asakadai Central General Hospital, Saitama, Japan. We excluded patients whose data were missing for various reasons, such as difficulties in recording, and those whose consciousness had recovered between HS-cv EEG and conventional cEEG (C-cEEG) monitoring. For the included patients, we performed HS-cv EEG monitoring followed by C-cEEG monitoring. Definitive diagnosis was confirmed by C-cEEG monitoring with the international 10–20 system. As the primary outcome, we verified the sensitivity and specificity of HS-cv EEG monitoring in detecting abnormal EEG patterns including PDs, RDA, SW, and CS, in detecting the presence of PDs, and in detecting NCSE. As the secondary outcome, we calculated the time to initiate HS-cv EEG monitoring after making the decision.

Results

Fifty patients (76.9%) were included in the final analyses. The median age was 72 years, and 66% of the patients were male. The sensitivity and specificity of HS-cv EEG monitoring for detecting abnormal EEG patterns were 0.974 (0.865–0.999) and 0.909 (0.587–0.998), respectively, and for detecting PDs were 0.824 (0.566–0.926) and 0.970 (0.842–0.999), respectively. We diagnosed 13 (26%) patients with NCSE using HS-cv EEG monitoring and could detect NCSE with a sensitivity and specificity of 0.706 (0.440–0.897) and 0.970 (0.842–0.999), respectively. The median time needed to initiate HS-cv EEG was 57 min (5–142).

Conclusions

HS-cv EEG monitoring is highly reliable in detecting abnormal EEG patterns, with moderate reliability for PDs and NCSE, and rapidly initiates cEEG monitoring in patients with AMS with unknown etiology.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Claassen J, Mayer SA, Kowalski RG, Emerson RG, Hirsch LJ. Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology. 2004;62(10):1743–8.

    Article  CAS  PubMed  Google Scholar 

  2. DeLorenzo RJ, Waterhouse EJ, Towne AR, Boggs JG, Ko D, DeLorenzo GA, Brown A, Garnett L. Persistent nonconvulsive status epilepticus after the control of convulsive status epilepticus. Epilepsia. 1998;39(8):833–40.

    Article  CAS  PubMed  Google Scholar 

  3. Vespa PM, Nuwer MR, Nenov V, Ronne-Engstrom E, Hovda DA, Bergsneider M, Kelly DF, Martin NA, Becker DP. Increased incidence and impact of nonconvulsive and convulsive seizures after traumatic brain injury as detected by continuous electroencephalographic monitoring. J Neurosurg. 1999;91(5):750–60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Towne AR, Waterhouse EJ, Boggs JG, Garnett LK, Brown AJ, Smith JR Jr, DeLorenzo RJ. Prevalence of nonconvulsive status epilepticus in comatose patients. Neurology. 2000;54(2):340–5.

    Article  CAS  PubMed  Google Scholar 

  5. Young GB, Doig GS. Continuous EEG monitoring in comatose intensive care patients: epileptiform activity in etiologically distinct groups. Neurocritical Care. 2005;2(1):5–10.

    Article  PubMed  Google Scholar 

  6. Alroughani R, Javidan M, Qasem A, Alotaibi N. Non-convulsive status epilepticus; the rate of occurrence in a general hospital. Seizure. 2009;18(1):38–42.

    Article  CAS  PubMed  Google Scholar 

  7. Gururangan K, Razavi B, Parvizi J. Utility of electroencephalography: experience from a U.S. tertiary care medical center. Clin Neurophysiol. 2016;127(10):3335–40.

    Article  PubMed  Google Scholar 

  8. Park A, Chapman M, McCredie VA, Debicki D, Gofton T, Norton L, Boyd JG. EEG utilization in Canadian intensive care units: a multicentre prospective observational study. Seizure. 2016;43:42–7.

    Article  PubMed  Google Scholar 

  9. Gavvala J, Abend N, LaRoche S, Hahn C, Herman ST, Claassen J, Macken M, Schuele S, Gerard E. Critical care EEG monitoring research consortium: continuous EEG monitoring: a survey of neurophysiologists and neurointensivists. Epilepsia. 2014;55(11):1864–71.

    Article  PubMed  Google Scholar 

  10. Hilkman DMW, van Mook W, Mess WH, van Kranen-Mastenbroek V. The use of continuous EEG monitoring in intensive care units in The Netherlands: a national survey. Neurocritical Care. 2018;29(2):195–202.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Brophy GM, Bell R, Claassen J, Alldredge B, Bleck TP, Glauser T, Laroche SM, Riviello JJ Jr, Shutter L, Sperling MR, et al. Guidelines for the evaluation and management of status epilepticus. Neurocritical Care. 2012;17(1):3–23.

    Article  PubMed  Google Scholar 

  12. Nitzschke R, Muller J, Engelhardt R, Schmidt GN. Single-channel amplitude integrated EEG recording for the identification of epileptic seizures by nonexpert physicians in the adult acute care setting. J Clin Monit Comput. 2011;25(5):329–37.

    Article  PubMed  Google Scholar 

  13. Young GB, Sharpe MD, Savard M, Al Thenayan E, Norton L, Davies-Schinkel C. Seizure detection with a commercially available bedside EEG monitor and the subhairline montage. Neurocritical Care. 2009;11(3):411–6.

    Article  PubMed  Google Scholar 

  14. Karakis I, Montouris GD, Otis JA, Douglass LM, Jonas R, Velez-Ruiz N, Wilford K, Espinosa PS. A quick and reliable EEG montage for the detection of seizures in the critical care setting. J Clin Neurophysiol. 2010;27(2):100–5.

    Article  PubMed  Google Scholar 

  15. Sutter R, Fuhr P, Grize L, Marsch S, Ruegg S. Continuous video-EEG monitoring increases detection rate of nonconvulsive status epilepticus in the ICU. Epilepsia. 2011;52(3):453–7.

    Article  PubMed  Google Scholar 

  16. Stewart CP, Otsubo H, Ochi A, Sharma R, Hutchison JS, Hahn CD. Seizure identification in the ICU using quantitative EEG displays. Neurology. 2010;75(17):1501–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Hirsch LJ, LaRoche SM, Gaspard N, Gerard E, Svoronos A, Herman ST, Mani R, Arif H, Jette N, Minazad Y, et al. American clinical neurophysiology society’s standardized critical care EEG terminology: 2012 version. J Clin Neurophysiol. 2013;30(1):1–27.

    Article  CAS  PubMed  Google Scholar 

  18. Zehtabchi S, Abdel Baki SG, Omurtag A, Sinert R, Chari G, Malhotra S, Weedon J, Fenton AA, Grant AC. Prevalence of non-convulsive seizure and other electroencephalographic abnormalities in ED patients with altered mental status. Am J Emerg Med. 2013;31(11):1578–82.

    Article  PubMed  Google Scholar 

  19. Kubota Y, Nakamoto H, Egawa S, Kawamata T. Continuous EEG monitoring in ICU. J Intensive Care. 2018;6:39.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Chong DJ, Hirsch LJ. Which EEG patterns warrant treatment in the critically ill? Reviewing the evidence for treatment of periodic epileptiform discharges and related patterns. J Clin Neurophysiol. 2005;22(2):79–91.

    Article  PubMed  Google Scholar 

  21. Leitinger M, Beniczky S, Rohracher A, Gardella E, Kalss G, Qerama E, Hofler J, Hess Lindberg-Larsen A, Kuchukhidze G, Dobesberger J, et al. Salzburg consensus criteria for non-convulsive status epilepticus-approach to clinical application. Epilepsy Behav. 2015;49:158–63.

    Article  CAS  PubMed  Google Scholar 

  22. Almojuela A, Hasen M, Zeiler FA. The full outline of unresponsiveness (FOUR) score and its use in outcome prediction: a scoping systematic review of the adult literature. Neurocritical Care. 2019;31(1):162–75.

    Article  CAS  PubMed  Google Scholar 

  23. Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48(3):452–8.

    Article  CAS  PubMed  Google Scholar 

  24. Varelas PN, Hacein-Bey L, Hether T, Terranova B, Spanaki MV. Emergent electroencephalogram in the intensive care unit: indications and diagnostic yield. Clin EEG Neurosci. 2004;35(4):173–80.

    Article  PubMed  Google Scholar 

  25. Leitinger M, Trinka E, Gardella E, Rohracher A, Kalss G, Qerama E, Hofler J, Hess A, Zimmermann G, Kuchukhidze G, et al. Diagnostic accuracy of the Salzburg EEG criteria for non-convulsive status epilepticus: a retrospective study. Lancet Neurol. 2016;15(10):1054–62.

    Article  PubMed  Google Scholar 

  26. Sen-Gupta I, Schuele SU, Macken MP, Kwasny MJ, Gerard EE. “Ictal” lateralized periodic discharges. Epilepsy Behav. 2014;36:165–70.

    Article  PubMed  Google Scholar 

  27. Kurtz P, Gaspard N, Wahl AS, Bauer RM, Hirsch LJ, Wunsch H, Claassen J. Continuous electroencephalography in a surgical intensive care unit. Intensive Care Med. 2014;40(2):228–34.

    Article  PubMed  Google Scholar 

  28. Rubinos C, Reynolds AS, Claassen J. The Ictal-interictal continuum: to treat or not to treat (and how)? Neurocritical Care. 2018;29(1):3–8.

    Article  PubMed  Google Scholar 

  29. Claassen J. How I treat patients with EEG patterns on the ictal-interictal continuum in the neuro ICU. Neurocritical Care. 2009;11(3):437–44.

    Article  PubMed  Google Scholar 

  30. Witsch J, Frey HP, Schmidt JM, Velazquez A, Falo CM, Reznik M, Roh D, Agarwal S, Park S, Connolly ES, et al. Electroencephalographic periodic discharges and frequency-dependent brain tissue hypoxia in acute brain injury. JAMA Neurol. 2017;74(3):301–9.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Laccheo I, Sonmezturk H, Bhatt AB, Tomycz L, Shi Y, Ringel M, DiCarlo G, Harris D, Barwise J, Abou-Khalil B, et al. Non-convulsive status epilepticus and non-convulsive seizures in neurological ICU patients. Neurocritical Care. 2015;22(2):202–11.

    Article  PubMed  Google Scholar 

  32. Rodriguez Ruiz A, Vlachy J, Lee JW, Gilmore EJ, Ayer T, Haider HA, Gaspard N, Ehrenberg JA, Tolchin B, Fantaneanu TA, et al. Association of periodic and rhythmic electroencephalographic patterns with seizures in critically ill patients. JAMA Neurol. 2017;74(2):181–8.

    Article  PubMed  Google Scholar 

  33. Gosavi TD, See SJ, Lim SH. Ictal and interictal EEG patterns in patients with nonconvulsive and subtle convulsive status epilepticus. Epilepsy Behav. 2015;49:263–7.

    Article  PubMed  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Neurointensive Care Unit, Department of Neurosurgery, and Stroke and Epilepsy Center, TMG Asaka Medical Center, Saitama, Japan

    Satoshi Egawa

  2. Department of Emergency and Critical Care Medicine, St. Luke’s International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan

    Toru Hifumi

  3. Department of Neurosurgery, Saiseikai Kurihashi Hospital, Saitama, Japan

    Hidetoshi Nakamoto

  4. Emergency Medical Center, Kagawa University Hospital, Kagawa, Japan

    Yasuhiro Kuroda

  5. Department of Neurosurgery, and Stroke and Epilepsy Center, TMG Asaka Medical Center, Saitama, Japan

    Yuichi Kubota

Authors
  1. Satoshi Egawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Toru Hifumi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hidetoshi Nakamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yasuhiro Kuroda
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yuichi Kubota
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Satoshi Egawa and Toru Hifumi were responsible for conception of the article and drafted and revised the manuscript. Yuichi Kubota and Yasuhiro Kuroda helped to make a study design and draft the manuscript. Hidetoshi Nakamoto helped to draft the manuscript. All authors have read and approved the final manuscript and take full responsibility for all aspects of the study.

Corresponding author

Correspondence to Toru Hifumi.

Ethics declarations

Conflict of interest

The authors declare a conflict of interest with Nihon Kohden as a cooperative research.

Ethical approval/informed consent

The protocol and consent procedures were approved by the Institutional Review Board.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Egawa, S., Hifumi, T., Nakamoto, H. et al. Diagnostic Reliability of Headset-Type Continuous Video EEG Monitoring for Detection of ICU Patterns and NCSE in Patients with Altered Mental Status with Unknown Etiology. Neurocrit Care 32, 217–225 (2020). https://doi.org/10.1007/s12028-019-00863-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12028-019-00863-9

Keywords

Search

Navigation