Transcript STAT (Ememgent) EEGs

STAT (Ememgent) EEGs
Nonconvulsive Status Epilepticus
• Emergency – pathological condition which is
life threatening or which can lead to organ
failure requiring prompt treatment in order to
avoid severe worsening and/or severe sequels
Neurophysiologie Clinique 1998
STAT
• From Latin statim - immediately
Problems
• Poor use of time and resources
– Detriment of patients who really need stat
procedures
– Increased turnaround time of non-STAT
procedures
•
•
•
•
Staffing difficulties
Increasing use of overtime
Frustration and strain on staff and physicians
STAT EEG is not like STAT EKG
Benbadis 2008
• Performed emergently
• Interpreted emergently
• Acted upon emergently
• 256 emegent EEGs (total 2798 EEGs)
– Useful helped in diagnosis, therapy or exclusion of
specific condition
– Corroborative
– Not useful
Khan et al., Clin Neurophysiol 2005
• Epilepsy related indictions(status epilepticus
and followup, recurrent seizures,
nonconvulsive status) – 93% useful
• Other conditions – 52.6% useful
Khan et al., Clin Neurophysiol., 2005
• 111 consecutive eEEGs
• Change in treatment – 37.8%
Praline et al. 2007
• 32 emergent pediatric EEGs (1.8 % of total)
• Useful in decision making 30/32 (94 %)
• Neurologist approved all of studies
Kothare et al. J Child Neurol 2005
Comparison of NCSE (12) and non-NCSE
(36)
•
•
•
•
•
•
•
•
Duration of symptoms
Remote risk factors*
Recent risk factors
Tonic-clonic activity in current episode
History of epilepsy
Mental state/Glasgow coma scale*
Ocular movement abnormalities*
Subtle motor abnormalities
Husain et al., JNNP 2002
Remote risk factors
•
•
•
•
•
Previous stroke
Previous neurosurgery
Tumor
Dementia
Meningitis
Husain et al. JNNP 2002
Eye movement abnormalities
•
•
•
•
Nystagmoid eye jerks
Hippus
Repeated blinking
Persistent eye deviation
Husain et al., JNNP 2002
Sensitivity (%)
Specificity (%)
Recent risk factors
75
28
Remote risk factors
75
58
Tonic-clonic activity
50
58
History of epilepsy
17
72
Ocular movement
abnormalities
50
86
Subtle motor activity
75
44
Husain et al. JNNP 2002
• 78 emergent EEGs
– 8 NCSE
• Risk factors
– History of epilepsy
– Observed GTCS
– Seizure-like motor activity
R. Khan, J Natl Med Assn, 2001
• All patients (8) with NCSE had at least one risk
factor
• 35 patients had at least one risk factor
• 43 patients had no risk factors – none had
NCSE
R. Khan et al, J Natl Med Assn,2001
Seizure like motor activity
•
•
•
•
•
Myoclonus
Nystagmoid eye movements
Eyelid fluttering
Conjugate eye deviations
Focal or multifocal twitching of the extremities
R. Khan, J Natl Med Assn, 2001
Patients with “seizure like” motor
activity
• 10 – EEG slowing (nonspecific)
• 1 - NCSE
R. Khan, J. Natl Med Assn
HUP study
• 152 patients to characterize specific events
– Seizure incidence 31%
• 363 patients with altered mental status
– Seizure incidence 29%
• Majority of movements in ICU are nonepileptic
• Facial and eye twitching high correlate with
seizure activity
• 52 cEEG studies for “possible seizures”
• 14 (27%) had epileptic seizures
• 38 (73%) had non-epileptic events
– Tremor
– Myoclonus
– Slow semi-purposeful movements
– Miscellaneous
Benbadis, Epilepsia, 2010