How Seizure Detection by Continuous Electroencephalographic Monitoring Affects the Prescribing of Antiepileptic Medications

Abstract

Objectives:To assess the effect of continuous electroencephalographic monitoring on the decision to treat seizures in the inpatient setting, particularly in the intensive care unit.Design: Retrospective cohort study.Setting: Medical and neuroscience intensive care units and neurological wards.Patients: Three hundred consecutive nonelective continuous electroencephalographic monitoring studies, performed on 287 individual inpatients over a 27month period.Main Outcome Measures: Epileptiform electroencephalographic abnormalities and changes in antiepi-leptic drug (AED) therapy based on the electroencephalographic findings.Results: The findings from the continuous electroencephalographic monitoring led to a change in AED prescribing in 52% of all studies with initiation of an AED therapy in 14%, modification of AED therapy in 33%, and discontinuation of AED therapy in 5% of all studies. Specifically, the detection of electrographic seizures led to a change in AED therapy in 28% of all studies. Conclusions:The findings of continuous electroencephalographic monitoring resulted in a change in AED prescribing during or after half of the studies performed. Most AED changes were made as a result of the detection of electrographic seizures.

Prescription patterns for routine EEG ordering in patients with intracranial hemorrhage admitted to a neurointensive care unit

“…In this respect it is notable that physician notes indicated that EEG informed their clinical decision-making in 60.2% of cases in our study. This is consistent with previous investigations reporting ASD adjustment in 46% [24] to 52% [32] of ICU patients undergoing EEG [24,32]. Considering this, and the fact that only 41% of patients who fulfilled criteria in our study underwent EEG, raises concerns that clinical decision-making remained suboptimal in the studied cohort.…”

Prescription patterns for routine EEG ordering in patients with intracranial hemorrhage admitted to a neurointensive care unit

“…In this respect it is notable that physician notes indicated that EEG informed their clinical decision-making in 60.2% of cases in our study. This is consistent with previous investigations reporting ASD adjustment in 46% [24] to 52% [32] of ICU patients undergoing EEG [24,32]. Considering this, and the fact that only 41% of patients who fulfilled criteria in our study underwent EEG, raises concerns that clinical decision-making remained suboptimal in the studied cohort.…”

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

“…In the last three decades, EEG had lost importance in the investigation of cerebral diseases, but several studies have shown the utility of EEG in conditions other than epilepsy, including evaluation of prognosis in coma. In our study, the EEG confirmed the diagnosis in 39.6% of the cohort and ruled out in 32.3%, being comparable with earlier studies 3,13,16,17 . T3 -T5 T5 -01 Fp1 -F3 F3 -C3 C3 -P3 P3 -01 Fp2 -F4 F4 -C4 C4 -P4 P4 -02 F8 -T4 T4 -T6 1 In our cohort, the most common reason for EEG requisition was to investigate unexplained altered level of consciousness (36.3%), to evaluate convulsive status epilepticus (31.9%) and nonconvulsive status epilepticus (23.1%).…”

Utility of Clinical Features in Identifying Electrographic Seizures in Hospitalized Patients Admitted for Non-Neurological Diagnoses

“…It also suggests that ESz independently contribute to negative patient outcomes regardless of underlying severity of medical illness. There was also a significant difference in patients on ASMs after electroencephalogram use in the Sz-EEG group compared with the No-Sz-EEG group ( p ≤ 0.001), which supports findings shown in previous work ( 26 , 27 ). However, this study was not designed to assess if the use of ASMs in these patients affected long-term outcomes.…”

Prescription patterns for routine EEG ordering in patients with intracranial hemorrhage admitted to a neurointensive care unit

“…In this respect it is notable that physician notes indicated that EEG informed their clinical decision-making in 60.2% of cases in our study. This is consistent with previous investigations reporting ASD adjustment in 46% [24] to 52% [32] of ICU patients undergoing EEG [24,32]. Considering this, and the fact that only 41% of patients who fulfilled criteria in our study underwent EEG, raises concerns that clinical decision-making remained suboptimal in the studied cohort.…”

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

“…In the last three decades, EEG had lost importance in the investigation of cerebral diseases, but several studies have shown the utility of EEG in conditions other than epilepsy, including evaluation of prognosis in coma. In our study, the EEG confirmed the diagnosis in 39.6% of the cohort and ruled out in 32.3%, being comparable with earlier studies 3,13,16,17 . T3 -T5 T5 -01 Fp1 -F3 F3 -C3 C3 -P3 P3 -01 Fp2 -F4 F4 -C4 C4 -P4 P4 -02 F8 -T4 T4 -T6 1 In our cohort, the most common reason for EEG requisition was to investigate unexplained altered level of consciousness (36.3%), to evaluate convulsive status epilepticus (31.9%) and nonconvulsive status epilepticus (23.1%).…”

Utility of Clinical Features in Identifying Electrographic Seizures in Hospitalized Patients Admitted for Non-Neurological Diagnoses

“…It also suggests that ESz independently contribute to negative patient outcomes regardless of underlying severity of medical illness. There was also a significant difference in patients on ASMs after electroencephalogram use in the Sz-EEG group compared with the No-Sz-EEG group ( p ≤ 0.001), which supports findings shown in previous work ( 26 , 27 ). However, this study was not designed to assess if the use of ASMs in these patients affected long-term outcomes.…”

Prescription patterns for routine EEG ordering in patients with intracranial hemorrhage admitted to a neurointensive care unit

“…In this respect it is notable that physician notes indicated that EEG informed their clinical decision-making in 60.2% of cases in our study. This is consistent with previous investigations reporting ASD adjustment in 46% [24] to 52% [32] of ICU patients undergoing EEG [24,32]. Considering this, and the fact that only 41% of patients who fulfilled criteria in our study underwent EEG, raises concerns that clinical decision-making remained suboptimal in the studied cohort.…”

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

“…In the last three decades, EEG had lost importance in the investigation of cerebral diseases, but several studies have shown the utility of EEG in conditions other than epilepsy, including evaluation of prognosis in coma. In our study, the EEG confirmed the diagnosis in 39.6% of the cohort and ruled out in 32.3%, being comparable with earlier studies 3,13,16,17 . T3 -T5 T5 -01 Fp1 -F3 F3 -C3 C3 -P3 P3 -01 Fp2 -F4 F4 -C4 C4 -P4 P4 -02 F8 -T4 T4 -T6 1 In our cohort, the most common reason for EEG requisition was to investigate unexplained altered level of consciousness (36.3%), to evaluate convulsive status epilepticus (31.9%) and nonconvulsive status epilepticus (23.1%).…”

Utility of Clinical Features in Identifying Electrographic Seizures in Hospitalized Patients Admitted for Non-Neurological Diagnoses

“…It also suggests that ESz independently contribute to negative patient outcomes regardless of underlying severity of medical illness. There was also a significant difference in patients on ASMs after electroencephalogram use in the Sz-EEG group compared with the No-Sz-EEG group ( p ≤ 0.001), which supports findings shown in previous work ( 26 , 27 ). However, this study was not designed to assess if the use of ASMs in these patients affected long-term outcomes.…”