The diagnostic value of continuous EEG for the detection of non-convulsive status epilepticus in neurosurgical patients – A prospective cohort study

Abstract

Highlights The incidence of seizure activity was 10%. Seizure activity was detected within the first 30 min in three of the five patients. Markers for patient selection for cEEG in neurosurgical patients are needed.

Does continuous electroencephalography influence therapeutic decisions in neurocritical care?

“…Our results confirm that SE is common in patients in neurocritical care, but the prevalence of seizure activity in this study is even higher than previously reported. A review of the literature on cEEG and detection of status epilepticus and seizures in adults published in the past 5 years are provided in Table 3 14,17–40 . 51–59 Most studies on seizures activity and cEEG performed in neurocritically ill patients are from the United States.…”

“…To test the ability of STESS to accurately classify SE outcomes, sensitivity and specificity were analyzed for high STESS score (3-6) and in-hospital death. The sensitivity was 80% (28-99), the specificity 40% (24-58), the negative predictive value 93 (70-99), and the positive predictive value 16 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24).…”

Cerebral monitoring in surgical ICU patients

“…The mortality at discharge was similar in patients with and without seizures, but outcomes in a longer time-frame were not investigated [9 ▪ ]. Another prospective study found a lower incidence (10%) of electrographic seizures in neurosurgical patients with clinical suspicion of nonconvulsive status epilepticus [10], even though the incidence was likely underestimated as antiepileptic medications had already been started in one third of patients. Factors associated with a higher risk of seizures after neurosurgery include a history of epilepsy, subdural hematoma, perioperative subarachnoid hemorrhage, and lobar tumor [9 ▪ ,11].…”

Quantitative burst suppression on serial intermittent EEG in refractory status epilepticus

“…While most recent studies assessing the optimal degree of BS have used continuous EEG (cEEG) ( Claassen et al, 2002 , Rossetti and Lowenstein, 2011 , Johnson et al, 2016 , Phabphal et al, 2018 ), many centers lack access and must default to serial intermittent EEG (siEEG) in SE management ( Zehtabchi et al, 2020 ). While diagnostic clarification could be achieved in 96% of neurosurgical patients with clinical suspicion of nonconvulsive SE using the initial 30 min of EEG ( Krøigård et al, 2019 ), intermittent EEG may fail to detect seizures which follow circadian cycles ( Baud et al, 2021 ). The resultant uncertainty between intermittent recordings may bias IVAT toward BS to minimize the chance of seizure recurrence when there are literally no data.…”