Use of EEG monitoring and management of non-convulsive seizures in critically ill patients: a survey of neurologists.
BACKGROUND
Continuous EEG monitoring (cEEG) of critically ill patients is frequently utilized to detect non-convulsive seizures (NCS) and status epilepticus (NCSE). The indications for cEEG, as well as when and how to treat NCS, remain unclear. We aimed to describe the current practice of cEEG in critically ill patients to define areas of uncertainty that could aid in designing future research.


METHODS
We conducted an international survey of neurologists focused on cEEG utilization and NCS management.


RESULTS
Three-hundred and thirty physicians completed the survey. 83% use cEEG at least once per month and 86% manage NCS at least five times per year. The use of cEEG in patients with altered mental status was common (69%), with higher use if the patient had a prior convulsion (89%) or abnormal eye movements (85%). Most respondents would continue cEEG for 24 h. If NCS or NCSE is identified, the most common anticonvulsants administered were phenytoin/fosphenytoin, lorazepam, or levetiracetam, with slightly more use of levetiracetam for NCS than NCSE.


CONCLUSIONS
Continuous EEG monitoring (cEEG) is commonly employed in critically ill patients to detect NCS and NCSE. However, there is substantial variability in current practice related to cEEG indications and duration and to management of NCS and NCSE. The fact that such variability exists in the management of this common clinical problem suggests that further prospective study is needed. Multiple points of uncertainty are identified that require investigation.
Abend
Nicholas S
NS
Division of Neurology, The Children's Hospital of Philadelphia, 34th Street and Civic Center Blvd, Philadelphia, PA 19104, USA. abend@email.chop.edu
Dlugos
Dennis J
DJ
Hahn
Cecil D
CD
Hirsch
Lawrence J
LJ
Herman
Susan T
ST
D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D002648:Child; D016292:Procedural Sedation; D003422:Critical Care / Q000706:statistics & numerical data*; D003625:Data Collection; D004569:Electroencephalography / Q000706:statistics & numerical data*; D004829:Epilepsy, Generalized / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D008991:Monitoring, Physiologic / Q000706:statistics & numerical data*; D009462:Neurology; D012815:Signal Processing, Computer-Assisted; D013226:Status Epilepticus / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology
D000927:Anticonvulsants