Comparing the Utility of Rapid Response EEG and Conventional EEG Recordings in a Multicenter Clinical Study
Abstract number :
1.145
Submission category :
3. Neurophysiology / 3B. ICU EEG
Year :
2021
Submission ID :
1826686
Source :
www.aesnet.org
Presentation date :
12/4/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:55 AM
Authors :
Deepika Kurup, AB - Stanford University School of Medicine; Kapil Gururangan, MD - Resident Physician, Neurology, Icahn School of Medicine at Mount Sinai; Masoom Desai, MD - Neurology - University of Oklahoma Health Science Center; Matthew Markert, MD, PhD - Neurology & Neurological Sciences - Stanford University School of Medicine; Dawn Eliashiv, MD - Neurology - University of California Los Angeles David Geffen School of Medicine; Josef Parvizi, MD, PhD - Neurology & Neurological Sciences - Stanford University School of Medicine
Rationale: A recent multicenter prospective study (DECIDE study) examined the use of Rapid Response EEG (Rapid-EEG; Ceribell Inc., Mountain View, CA) in the evaluation and management of suspected non-convulsive seizures. We present a detailed, patient-level examination of initial Rapid-EEG and subsequent conventional EEG to investigate whether seizures were missed on Rapid-EEG due to the exclusion of midline/parasagittal coverage.
Methods: We identified the subset of patients in the DECIDE study with seizures detected on Rapid-EEG only (n=6), conventional EEG only (n=4), or both Rapid-EEG and conventional EEG (n=9). We examined the characteristics of seizures and associated epileptiform EEG findings, including focality with regard to detection in lateral or midline/parasagittal chains, on both devices and patient clinical histories to identify contributors towards discordant diagnoses.
Results: Seizures detected on both systems in 9 patients had similar electrographic appearance and location. Conventional EEG detected seizures within 24 hours following Rapid-EEG in 4 patients; in these cases, seizures were visible in the temporal chains (i.e., not restricted to the midline/parasagittal regions) and external clinical factors (empiric treatment with anti-seizure medications, weaning sedation) explained the delayed presentation of seizures. In 6 cases, seizures were detected only by Rapid-EEG but were absent in the next 24 hours of conventional EEG recording after patients were treated with anti-seizure medications, and post-ictal highly epileptiform patterns seen on conventional EEG displayed similar focality.
Conclusions: Our case series extends the previously reported findings that electrographic data obtained with Rapid-EEG is largely concordant with that from subsequent conventional EEG monitoring. Delayed seizure detection on conventional EEG, but not Rapid-EEG, could be related to treatment with anti-seizure medications rather than reduction in electrode coverage sparing the midline/parasagittal regions. Larger studies in the future could provide meaningful information about the value of EEG findings in Rapid-EEG for forecasting and predicting seizures in long-term EEG recordings.
Funding: Please list any funding that was received in support of this abstract.: JP is inventor of Rapid Response EEG System and co-founder of Ceribell Inc., which is commercializing the Rapid Response EEG System for clinical use. KG and MSM serve as scientific advisors to Ceribell Inc., and KG received consulting fees from Ceribell Inc. for his contributions to this report. DK, MJD, and DSE report no relevant disclosures.
Neurophysiology