Paroxysmal events in critically ill patients: Diagnostic yield and clinical impact of long term EEG
Abstract number :
2.393
Submission category :
3. Neurophysiology / 3B. ICU EEG
Year :
2021
Submission ID :
1886427
Source :
www.aesnet.org
Presentation date :
12/9/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:56 AM
Authors :
Hai Chen, MD, PhD - George Washington University; Mohamad Koubeissi, MD – George Washington University; Jennifer Pauldurai, MD – George Washington University; Eugenie Atallah, MD – George Washington University
Rationale: Long term EEG study (LTM) has been widely used in ICU to evaluate altered mental status and detect non-convulsive seizures. Here, we aim to investigate the yield of LTM in evaluating paroxysmal events and identify potential predictors for the yield of monitoring. Clinical impact of LTM was evaluated by detecting anti-seizure medication (ASM) changes following the LTM.
Methods: We identified patients in the ICU who underwent LTM monitoring ( > 6 h) to evaluate paroxysmal events between Jan 1, 2018 and Dec 31, 2019. We extracted patient demographics, medical history, neurological examination, brain imaging results, as well as the description of paroxysmal event that necessitated the monitoring. The LTM was dichotomized into either a diagnostic or a non-diagnostic study. A recording with findings of epileptic discharges (ictal or interictal) or a captured habitual event is considered a diagnostic study. We also documented ASMs prior to and after LTM.
Results: We identified 159 recordings that were obtained for the indication of a paroxysmal events, of which abnormal movements constituted the majority (n = 113). For the rest of paroxysmal events (n = 46), descriptions included gaze deviations, speech changes, sensory changes. The table 1 shows patient demographic information and characteristics. (Table 1) Diagnostic LTM studies accounted for 29% (46/159) of the recordings and findings included interictal epileptiform discharges (n = 33) and captured habitual non-epileptic events (n=13). History of epilepsy is the predictor of the study outcome. First detection of abnormal finding occurred within 6 hours of the recording in most patients (30/46, 65%). Overall, LTM studies lead to 49 (33%) changes in ASM administration. The changes included dosage increases or initiation of ASM in patients with epileptiform discharges (n = 28) and reduction or elimination of ASM in patients with either habitual non-epileptic events (n = 5) or non-diagnostic LTM studies (n = 16). (Table 2).
Conclusions: LTM is valuable in evaluating paroxysmal events with a diagnostic yield of 29% in critically ill patients. A history of epilepsy predicts the diagnostic study findings. Both diagnostic and non-diagnostic LTM studies may directly impact clinical decisions by leading to ASMs changes.
Funding: Please list any funding that was received in support of this abstract.: None.
Neurophysiology