Practical Considerations When Performing Neurodiagnostic Studies on Patients with COVID-19 and Other Highly Virulent Diseases

Abstract

technologist. At this critical moment in time, we hope such modifications will allow us to continue delivering high quality patient care while optimizing resource utilization and above all keeping our technologists safe.

Practice Guidelines for Canadian Neurophysiology Laboratories During the COVID-19 Pandemic

“…1,2 As the pandemic starts to come under control and laboratories gain greater experience with safely seeing patients, the threshold for selecting appropriate patients for neurophysiological testing will become progressively lower. [3][4][5][6] Patient workflow should still be adjusted in order to assess high-risk cases safely. 1,3 In COVID-19-positive cases, neurodiagnostic testing should be performed only in the inpatient setting with full personal protective equipment (PPE) equipment as per local protocols, only if test results will change management (treatment and/or diagnosis), and ideally in an airborne infection isolation room (AIIR) as the virus could survive several hours to days on certain surfaces.…”

“…2,4,7 If done in AIIR, these tests should be postponed for at least 4 h if recent aerosol generating medical procedure (AGMP) had been performed (i.e., nebulizer therapy, chest physiotherapy, intubation, bronchoscopy, sputum induction, bilevel positive airway pressure [BiPAP], or continuous positive airway pressure [CPAP] use). 5,7 The outpatient setting is reserved for COVID-19-negative patients when triaging deems necessary. [3][4][5][6]8 The waiting room must be utilized in a way that will allow a 2-m gap (physical distancing) between patients, including not concomitant bookings if needed due to limited physical space.…”

“…4,5 Hyperventilation should not be routinely performed, but if justified for high diagnostic yield (e.g., pediatric absence epilepsy), patients must wear surgical masks. [4][5][6] Utilization of surgical mask and goggles or N95 and facial shield should be considered for inpatients when in the ward or intensive care units (ICUs), respectively. In COVID-19positive patients, the second facial protection combination is preferred.…”

“…2,4,14 As a possible EMU alternative, ambulatory EEG should include video, ideally with outpatient dis/connection external to hospital, plastic covering for community COVID-19 settings, and allowing a "rest period" between uses for potentially difficult to disinfect ambulatory pieces (e.g., pouches and straps), while keeping in mind battery limitations. [4][5][6]14 NEUROSTIMULATION (TABLE 3) If stable, consider using virtual visits and deferring programmatic changes, with alternatives such as optimizing anti-seizure medications and instituting a rescue medication strategy. While vagus nerve stimulator (VNS) auto-titration and deep brain stimulation (DBS) program sets allow automated changes, decompensation may occur in remote settings, and surgical procedures may be limited even in urban centres.…”

Response to Canadian Neurophysiology Laboratory COVID-19 Practice Guidelines

“…The authors cite three articles in support of their guideline on hyperventilation (Haines et al, 2020; San-Juan et al, 2020; Sethi, 2020);[6][7][8] however, only one appears to even partially supporttheir position. The article by Sethi is a short letter to the editor by a New York-based epileptologist describing his experiences adjusting laboratory practices during a period of overwhelming COVID-19 infections; there is no mention of hyperventilation.…”