Emergent EEG in clinical practice

Praline, Julien; Grujic, Jéléna; Corcia, Philippe; Lucas, B.; Hommet, Caroline; Autret, A; Toffol, Bertrand de

doi:10.1016/j.clinph.2007.07.003

Cited by 61 publications

(64 citation statements)

References 30 publications

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“…However, the EEG is also useful in the investigation of other neurological disorders, in addition to epilepsy, or in cases of symptomatic epilepsy (secondary to a disorder-based). The demonstration of nonepileptiform EEG abnormalities in patients with altered mental status or level of consciousness, for example, can be especially useful in guiding decision making and the best treatment [2][3][4] . The EEG provides valuable information on the investigation of patients with signs of acute cerebral suffering, rapidly progressive dementia, toxicmetabolic encephalopathy, coma and brain death, among others [2][3][4] .…”

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confidence: 99%

“…The demonstration of nonepileptiform EEG abnormalities in patients with altered mental status or level of consciousness, for example, can be especially useful in guiding decision making and the best treatment [2][3][4] . The EEG provides valuable information on the investigation of patients with signs of acute cerebral suffering, rapidly progressive dementia, toxicmetabolic encephalopathy, coma and brain death, among others [2][3][4] . It is worth remembering that the non-epileptiform EEG abnormalities may be present in patients with epilepsy [5][6][7][8][9] .…”

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Non-epileptiform EEG abnormalities: an overview

Andraus¹,

Alves-Leon

2011

Arq. Neuro-Psiquiatr.

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More than 80 years after its introduction by Hans Berger, the electroencephalogram (EEG) remains as an important supplementary examination in the investigation of neurological disorders and gives valuable and accurate information about cerebral function. Abnormal EEG findings may include ictal patterns, interictal epileptiform activity and non-epileptiform abnormalities. The aim of this study is to make an overview on the main non-epileptiform EEG abnormalities, emphasizing the pathologic findings and the importance of their recognition, excluding periodic patterns and EEG physiologic changes. Scientific articles were selected from MEDLINE and PubMed database. The presence of non-epileptiform EEG abnormalities provide evidence of brain dysfunction that are not specific to a particular etiology and may be related to a number of disorders affecting the brain. Although these abnormalities are not specific, they can direct attention to the diagnostic possibilities and guide the best treatment choice. Key words: abnormal EEG, non-epileptiform abnormalities, slow activity.Anormalidades eletrencefalográficas não epileptiformes: uma visão geral RESUMO Mais de 80 anos após sua introdução por Hans Berger, o eletrencefalograma (EEG) permanece como importante exame complementar na investigação de transtornos neurológicas e fornece informações valiosas e precisas a respeito da função cerebral. Achados eletrencefalográficos anormais podem incluir padrões ictais, atividade epileptiforme interictal e anormalidades eletrencefalográficas não epileptiformes. O objetivo deste estudo é fazer uma revisão das principais anormalidades eletrencefalográficas não epileptiformes, enfatizando os achados patológicos e a importância de seu reconhecimento, excluindo padrões periódicos e alterações eletrencefalográficas fisiológicas. Foram selecionados artigos científicos por meio de pesquisa nas bases de dados MEDLINE e PubMed. A presença de anormalidades eletrencefalográficas não epileptiformes fornece evidências de disfunção cerebral, as quais não são específicas para uma etiologia particular e podem estar relacionadas a uma série de desordens que afetam o encéfalo. Embora essas anormalidades não sejam específicas, elas podem direcionar a atenção para as possibilidades diagnósticas e guiar a escolha do melhor tratamento. Palavras-Chave: EEG anormal, anormalidades não epileptiformes, atividade lenta.

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Non-epileptiform EEG abnormalities: an overview

Andraus¹,

Alves-Leon

2011

Arq. Neuro-Psiquiatr.

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“…For example, researchers examining the use of EEGs in the management of patients who present with altered mental status reported that an EEG helped to establish the diagnosis in 56% of the cases, changed diagnostic management in 49% of cases, and changed treatment plans in 42% of the cases. 11 Similarly, Praline, Grujic, Corcia, and colleagues 12 note that EEGs ordered on an emergent basis in the ED as well as in the hospital contributed to the diagnosis in 78% of cases examined. Sadleir and Ingrid 13 report in a study performed on children presenting with first-time seizures that the rate of epileptiform discharge (uncontrolled electrical discharges in the brain associated with epilepsy, identified through EEGs) was 57% in patients on an EEG performed within 24 hours of the seizure, and another study of EEGs performed in adults and children within 24 hours of a firsttime seizure found a rate of epileptiform discharge of 47%.…”

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confidence: 99%

Patient-centered outcomes: a qualitative exploration of patient experience with electroencephalograms in the Emergency Department

Davis

Beverly

Hernandez‐Nino

et al. 2017

Qual Res Med Healthc

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Seizures are fear-inducing experiences for those having them and for their friends and family members. [1][2][3] Seizures comprise an estimated 1%-2% of all Emergency Department (ED) visits per year. 4 Despite that fact that patient-centered outcomes and shared decision-making models are widely promoted in healthcare today, no research has attempted to understand the ED experience from the point of view of first-time seizure patients and their families, including their experiences of the setting and pace of the typical components of a first-time seizure evaluation, diagnosis and treatment.The current ED practice standard for uncomplicated first time generalized seizures in adults evaluates patients for toxic, metabolic, structural, cardiogenic and systemic causes.5 If no abnormalities are identified, patients are instructed to refrain from at-risk activity (e.g. driving, swimming) and told to arrange follow-up with a neurologist. Since the standard neurologic evaluation for first-time seizures includes performance of an electroencephalogram (EEG) as an outpatient, patients must undergo an EEG after ED discharge. 5,6 Research has demonstrated the importance of performing early EEGs among first-time seizure patients for timely identification of epilepsy, as rapid diagnosis and immediate initiation of antiepileptic drug (AED) therapy after an epileptic seizure significantly reduces seizure risk in the short term by about 35%. 5,7 However, the barriers to appropriate outpatient follow-up and the important patient and family centered outcomes related to first time seizures in adults are poorly understood.In this paper, we utilize the concept of patient-centered outcomes to consider the patients' and families' experiences when deriving treatment options for first-time seizure patients. EEGs in the Emergency DepartmentThere has been virtually no research on Emergency Patient-centered outcomes: a qualitative exploration of patient experience with electroencephalograms in the Emergency Department ABSTRACTThe primary objective of this qualitative project was to understand the experience of patients who had first-time seizures and who did, and did not, have electroencephalograms (EEGs) performed in the Emergency Department (ED) as part of their initial evaluation, so as to refine the diagnostic and therapeutic approach to these patients and transform the standard of care for first-time seizures by focusing on outcomes as defined by patient experiences and expectations. In this paper, we show that, regardless of the diagnostic and therapeutic approach patients are given in the ED, patients and caregivers trust that health care providers will perform the standard of care consistent with the current medical practice for first-time seizures. However, performing EEGs in the ED and initiating appropriate anticonvulsant therapy for those patients who are at high risk for future seizures addresses patient needs by offering patients a sense of security and control over their medical condition and expediting appropriate follow up c...

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“…However, nowadays, it has received high attention as an important source of information, especially in situations such as unexplained impairment of consciousness [1][2][3] , since it may offer valuable real time information about brain activity, which can be decisive in some life-threatening situations, as convulsive status epilepticus (CSE) and nonconvulsive status epilepticus (NCSE), in which early recognition and ABStrAct Objectives: To assess the frequency of electroencephalogram (EEG) requests in the emergency room (ER) and intensive care unit (ICU) for patients with impairment of consciousness (IC) and its impact in the diagnosis and management. Methods: We followed patients who underwent routine EEG from ER and ICU with IC until discharge or death.…”

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confidence: 99%

“…immediately treatment may not only prevent death, but also offer better outcomes [1][2][3][4][5][6][7][8] . It might also give important clues in the diagnosis of certain conditions, such as encephalitis, hypoxic-anoxic brain injury, metabolic disturbances, intoxication and structural lesions 2,3,[9][10][11][12] .…”

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The impact of EEG in the diagnosis and management of patients with acute impairment of consciousness

Ricardo

França

Lima

et al. 2012

Arq. Neuro-Psiquiatr.

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With the advent of neuroimaging techniques, such as high resolution MRI, PET and SPECT, the importance of the electroencephalogram (EEG) in cerebral disease studies had decreased. However, nowadays, it has received high attention as an important source of information, especially in situations such as unexplained impairment of consciousness [1][2][3] , since it may offer valuable real time information about brain activity, which can be decisive in some life-threatening situations, as convulsive status epilepticus (CSE) and nonconvulsive status epilepticus (NCSE), in which early recognition and ABStrAct Objectives: To assess the frequency of electroencephalogram (EEG) requests in the emergency room (ER) and intensive care unit (ICU) for patients with impairment of consciousness (IC) and its impact in the diagnosis and management. Methods: We followed patients who underwent routine EEG from ER and ICU with IC until discharge or death. Results: During the study, 1679 EEGs were performed, with 149 (8.9%) from ER and ICU. We included 65 patients and 94 EEGs to analyze. Epileptiform activity was present in 42 (44.7%). EEG results changed clinical management in 72.2% of patients. The main reason for EEG requisition was unexplained IC, representing 36.3% of all EEGs analyzed. Eleven (33%) of these had epileptiform activity. Conclusion: EEG is underused in the acute setting. The frequency of epileptiform activity was high in patients with unexplained IC. EEG was helpful in confirming or ruling out the suspected initial diagnosis and changing medical management in 72% of patients.Key words: emergency EEG, impaired of consciousness, emergency room, intensive care unit. reSUMO Objetivo: Avaliar a frequência de exames de eletroencefalograma (EEG) solicitados no pronto-socorro (PS) e na unidade de terapia intensiva (UTI) em pacientes com rebaixamento do nível de consciência, bem como seu impacto no diagnóstico e na conduta. Métodos: Acompanhamos pacientes submetidos ao EEG do PS e da UTI com rebaixamento do nível de consciência até a alta ou óbito. Resultados: Realizamos 1679 EEGs no período de estudo; destes, 149 (8,9%) foram solicitados no PS e na UTI. Incluímos 65 pacientes e 94 EEGs para análise; destes, 42 (44,7%) apresentavam atividade epileptiforme. O EEG mudou a conduta em 72% dos pacientes. A razão principal para solicitação do EEG foi rebaixamento do nível de consciência de origem inexplicável (36,3% dos EEGs). Destes, 33% tinham atividade epileptiforme. Conclusão: Embora o EEG seja pouco usado em condições agudas, a frequência de atividade epileptiforme foi alta nos pacientes com rebaixamento do nível de consciência de origem inexplicável. O EEG foi decisivo para o esclarecimento diagnóstico e implicou mudança da conduta em 72% dos pacientes.Palavras-Chave: EEG de emergência, rebaixamento de consciência, pronto-socorro, unidade de terapia intensiva.immediately treatment may not only prevent death, but also offer better outcomes [1][2][3][4][5][6][7][8] . It might also give important clues in the diagnosis of certain...

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Emergent EEG in clinical practice

Cited by 61 publications

References 30 publications

Non-epileptiform EEG abnormalities: an overview

Non-epileptiform EEG abnormalities: an overview

Patient-centered outcomes: a qualitative exploration of patient experience with electroencephalograms in the Emergency Department

The impact of EEG in the diagnosis and management of patients with acute impairment of consciousness

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