Neurotelemetry
Why is it important?
Patients with Non-Convulsive Status Epilepticus
Patients with non-convulsive status epileticus (NCSE) treated and resolved within 10 hours had a
10% mortality vs. 85% mortality if the seizures continued longer than 20 hours.
For patients diagnosed within 30 mins of seizure onset, mortality was 36% compared with 75% for those patients diagnosed <24 hours after onset of seizures
Young B, Jordan K, Doig G., Neurology. 1996;47:83–9
cEEG in the ICU
Presence of non-convulsive seizures and non-convulsive status is an independent predictor of worse neurological outcome.
cEEG monitoring in the ICU lead to changes in AED prescribing in 51% of the cases. Most changes were made as a result of the detection of electrographic seizures.
The discovery of NCSz and NCSE are treatable cerebral emergencies that are associated with high mortality rates.
L J HIrsch, Epilepsy Curr. 2010 July; 10(4): 82–85.
cEEG in the ICU
20% of patients in stupor and coma are having nonconvulsive seizures and nonconvulsive status epilepticus
"Untreated, those can cause permanent brain injury or at least delay recovery from coma. ICU EEG monitoring also can identify other complications in time to intervene before permanent damage occurs,"
“This kind of monitoring (cEEG) can provide dynamic information to hospital staff about brain function that allows early detection of changes in neurologic status, which is especially valuable when the clinical examination is limited.
Marc R. Nuwer, MD PhD, Department of Neurology at the UCLA School of Medicine and Department of Clinical Neurophysiology
Benefits of cEEG
The reason that it is important to identify nonconvulsive seizures and non-convulsive status is that both discoveries represent treatable 'emergencies' that are associated with high mortality
When cEEG is combined with
individualized, physiologically driven decision making via multimodality brain monitoring, intensivists can identify when the brain is at risk for injury or when neuronal injury is already occurring and intervene before there is permanent
damage.
“cEEG monitoring led to a change in therapy in one-half the cases.”
Lawrence J. Hirsch MD
Professor of Neurology; Chief, Division of Epilepsy and EEG; Co-Director, Yale Comprehensive Epilepsy Center
Early Diagnosis of NCSE
Early Diagnosis of NCSE
For patients diagnosed with NCSE within 30 min of seizure onset, mortality was 36 % compared with 75 % for those patients diagnosed <24 h after seizure onset.
Patients with NCSE treated and resolved within 10 h had 10 % mortality vs. 85 % mortality if seizures continued longer than 20 h
Guidelines for long-term monitoring of epilespy.
American Clinical Neurophysiologiy Society
(Table 4 Prognosis)