title: A comparison of continuous video-EEG monitoring and 30-minute EEG in an ICU.
abstract: OBJECTIVE
  To determine whether there is added benefit in detecting electrographic abnormalities from 16-24 hours of continuous video-EEG in adult medical/surgical ICU patients, compared to a 30-minute EEG.
  
  
  METHODS
  This was a prospectively enroled non-randomized study of 130 consecutive ICU patients for whom EEG was requested. For 117 patients, a 30-minute EEG was requested for altered mental state and/or suspected seizures; 83 patients continued with continuous video-EEG for 16-24 hours and 34 patients had only the 30-minute EEG. For 13 patients with prior seizures, continuous video-EEG was requested and was carried out for 16-24 hours. We gathered EEG data prospectively, and reviewed the medical records retrospectively to assess the impact of continuous video-EEG.
  
  
  RESULTS
  A total of 83 continuous video-EEG recordings were performed for 16-24 hours beyond 30 minutes of routine EEG. All were slow, and 34% showed epileptiform findings in the first 30 minutes, including 2% with seizures. Over 16-24 hours, 14% developed new or additional epileptiform abnormalities, including 6% with seizures. In 8%, treatment was changed based on continuous video-EEG. Among the 34 EEGs limited to 30 minutes, almost all were slow and 18% showed epileptiform activity, including 3% with seizures. Among the 13 patients with known seizures, continuous video-EEG was slow in all and 69% had epileptiform abnormalities in the first 30 minutes, including 31% with seizures. An additional 8% developed epileptiform abnormalities over 16-24 hours. In 46%, treatment was changed based on continuous video-EEG.
  
  
  CONCLUSIONS
  This study indicates that if continuous video-EEG is not available, a 30-minute EEG in the ICU has a substantial diagnostic yield and will lead to the detection of the majority of epileptiform abnormalities. In a small percentage of patients, continuous video-EEG will lead to the detection of additional epileptiform abnormalities. In a sub-population, with a history of seizures prior to the initiation of EEG recording, the benefits of continuous video-EEG in monitoring seizure activity and influencing treatment may be greater.
authors.affiliation: St. Luke's University Health Center, Bethlehem, PA.
authors.forename: Omar I
authors.initials: OI
authors.lastname: Khan
authors.affiliation: Yale School of Medicine, New Haven, CT.
authors.forename: Christina J
authors.initials: CJ
authors.lastname: Azevedo
authors.affiliation: Mission Neurology, Asheville, NC.
authors.forename: Alendia L
authors.initials: AL
authors.lastname: Hartshorn
authors.affiliation: MidState Medical Center, Meriden, CT.
authors.forename: Justin T
authors.initials: JT
authors.lastname: Montanye
authors.affiliation: Erlanger Health System, Chattanooga, TN.
authors.forename: Juan C
authors.initials: JC
authors.lastname: Gonzalez
authors.affiliation: University of Texas Southwestern, Dallas, TX.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Natola
authors.affiliation: Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Surgenor
authors.affiliation: Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: Richard P
authors.initials: RP
authors.lastname: Morse
authors.affiliation: Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Nordgren
authors.affiliation: Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: Krzysztof A
authors.initials: KA
authors.lastname: Bujarski
authors.affiliation: University of Vermont, College of Medicine, Burlington VT, USA.
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Holmes
authors.affiliation: Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: Barbara C
authors.initials: BC
authors.lastname: Jobst
authors.affiliation: University of Vermont, College of Medicine, Burlington VT, USA.
authors.forename: Rod C
authors.initials: RC
authors.lastname: Scott
authors.affiliation: Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: Vijay M
authors.initials: VM
authors.lastname: Thadani
mesh_terms: D000328:Adult; D001927:Brain Diseases / Q000175:diagnosis*; D004569:Electroencephalography / Q000379:methods*; D004827:Epilepsy / Q000175:diagnosis*; D006801:Humans; D007362:Intensive Care Units; D008991:Monitoring, Physiologic / Q000379:methods*; D012189:Retrospective Studies; D014743:Videotape Recording / Q000379:methods*
keywords: ICU; continuous video-EEG; critically ill; non-convulsive status epilepticus