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Use of EEG Monitoring and Management of Non-Convulsive Seizures in Critically Ill Patients: A Survey of Neurologists

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Abstract

Background

Continuous EEG monitoring (cEEG) of critically ill patients is frequently utilized to detect non-convulsive seizures (NCS) and status epilepticus (NCSE). The indications for cEEG, as well as when and how to treat NCS, remain unclear. We aimed to describe the current practice of cEEG in critically ill patients to define areas of uncertainty that could aid in designing future research.

Methods

We conducted an international survey of neurologists focused on cEEG utilization and NCS management.

Results

Three-hundred and thirty physicians completed the survey. 83% use cEEG at least once per month and 86% manage NCS at least five times per year. The use of cEEG in patients with altered mental status was common (69%), with higher use if the patient had a prior convulsion (89%) or abnormal eye movements (85%). Most respondents would continue cEEG for 24 h. If NCS or NCSE is identified, the most common anticonvulsants administered were phenytoin/fosphenytoin, lorazepam, or levetiracetam, with slightly more use of levetiracetam for NCS than NCSE.

Conclusions

Continuous EEG monitoring (cEEG) is commonly employed in critically ill patients to detect NCS and NCSE. However, there is substantial variability in current practice related to cEEG indications and duration and to management of NCS and NCSE. The fact that such variability exists in the management of this common clinical problem suggests that further prospective study is needed. Multiple points of uncertainty are identified that require investigation.

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Acknowledgments

The Child Neurology Society, American Epilepsy Society, American Clinical Neurophysiology Society, and the Critical Care EEG Consortium (funded by the American Epilepsy Society) all generously supported this work by sending group email messages to their member lists.

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Authors and Affiliations

  1. Division of Neurology, The Children’s Hospital of Philadelphia, 34th Street and Civic Center Blvd, Philadelphia, PA, 19104, USA

    Nicholas S. Abend & Dennis J. Dlugos

  2. Division of Neurology, The Hospital For Sick Children, Toronto, Canada

    Cecil D. Hahn

  3. Comprehensive Epilepsy Center, Neurological Institute, Columbia University College of Physicians and Surgeons, New York, USA

    Lawrence J. Hirsch

  4. Department of Neurology, Beth Israel Deaconess Medical Center, Boston, USA

    Susan T. Herman

Authors
  1. Nicholas S. Abend
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  2. Dennis J. Dlugos
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  3. Cecil D. Hahn
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  4. Lawrence J. Hirsch
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  5. Susan T. Herman
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Correspondence to Nicholas S. Abend.

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Abend, N.S., Dlugos, D.J., Hahn, C.D. et al. Use of EEG Monitoring and Management of Non-Convulsive Seizures in Critically Ill Patients: A Survey of Neurologists. Neurocrit Care 12, 382–389 (2010). https://doi.org/10.1007/s12028-010-9337-2

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  • DOI: https://doi.org/10.1007/s12028-010-9337-2

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