Continuous EEG Research

As the healthcare industry continues to search for ways to optimize patient outcomes, cEEG monitoring has moved to the forefront of epilepsy and other neurological research studies.

Key research findings:

Continuous EEG Monitoring is recommended for all Level I and Level II NICUs:

Standards for Neurologic Critical Care Units: A Statement for Healthcare Professionals from The Neurocritical Care Society

Moheet A, Livesay S, Abdelhak T, et al, 2018

While a variety of systems to stratify stroke and trauma centers exist and geographical and economic factors may shape services offered, the system of stratification proposed here recognizes that high-quality neurocritical care services may be delivered in units without advanced research, academic or surgical programs and allows for flexibility in developing a program to meet the needs of the patients of any region.”

Over the past decade, the use of patients has increased and has become one of the most important tools in monitoring in the ICU:

Continuous Electroencephalography Monitoring in Adults in the Intensive Care Unit

Caricato A, Melchionda I, Antonelli M, 2018

“Neurologic monitoring in the intensive care unit (ICU) is based on the acquisition of several parameters from multiple brain devices. Electroencephalography (EEG) is one of the simplest ways to investigate cerebral activity, easily recorded at the bedside and sensitive to changes in both brain structure and function. Due to these features and its simple utilization, use of continuous EEG (cEEG) recording in critically ill patients has increased over the past decade.”

cEEG monitoring is recommended for patients with post-cardiac arrest syndrome:

Critical Care Management Focused on Optimizing Brain Function After Cardiac Arrest

Nakashima R, Hifumi T, Kawakita K, et al, 2017

“The incidence of non-convulsive seizures after cardiac arrest is from 12 percent to 24 percent in adults and up to 47 percent in pediatric cardiac arrest cases. Some studies indicate that seizures occur most often within the first 8 hours after ROSC (return of spontaneous circulation), according to continuous EEG (cEEG) records. Seizures are masked by neuromuscular blockage (NMB) in between 3 percent and 44 percent of cases. For these reasons, it is recommended to use cEEG for patients with PCAS (post-cardiac arrest syndrome).”

cEEG monitoring has clear benefits over standard EEG:

Continuous electroencephalographic-monitoring in the ICU: an overview of current strengths and future challenges

Hilkman D, van Mook W, van Kranen-Mastenbroek V, 2017

“Utilization of ICU cEEG has significantly improved detection and characterization of cerebral pathology, prognostication and clinical management in specific patient groups…In selected critically ill patient groups, ICU cEEG has clear benefits over (repeated) standard EEG or no functional brain monitoring at all and if available, cEEG should be used.”

A new pathway to standardize EEG monitoring and seizure management in encephalopathic critically ill children:

Impact of an ICU EEG Monitoring Pathway on Timeliness of Therapeutic Intervention and Electrographic Seizure Termination

Williams R, Banwell B, Berg R, et al, 2016

“Implementation of the pathway resulted in a significant reduction in the duration between electrographic seizure onset and anti-seizure medication administration, and a significant increase in the rate of electrographic seizure termination following an initial anti-seizure medication.”

Transferring critically ill patients:

Transferring the critically ill: are we there yet?

Droogh J, Smit M, Absalom A, et al, 2015

“During the past few decades the numbers of ICUs and beds has increased significantly, but so too has the demand for intensive care. Currently, large and increasing numbers of critically ill patients require transfer between critical care units. Inter-unit transfer poses significant risks to critically ill patients, particularly those requiring multiple organ support.”

Qualifications of personnel performing and interpreting CCEEG, equipment, documentation, and safety:

Consensus Statement on Continuous EEG in Critically Ill Adults and Children, Part II: Personnel, Technical Specifications and Clinical Practice

Herman S, Abend N, Bleck T, et al, 2015

“Due to resource limitations, cEEG is typically acquired continuously and reviewed intermittently by neurodiagnostic technologists (NDTs) for technical quality and changes in EEG patterns and also intermittently by electrophalographers for interpretation and correlation.”

Electroencephalography (EEG) measures the brain’s electrical activity:

Consensus Statement on Continuous EEG in Critically Ill Adults and Children, Part I: Indications

Herman S, Abend N, Bleck T, et al, 2015

“Over the past decade, technical advances have improved the efficiency of continuous EEG (cEEG) recording and remote review, leading to a greater than four-fold increase in the number of cEEGs performed in intensive care units (ICUs). Recent surveys, however, show variability in why and how cEEG is performed in the ICU, highlighting the need for clinical guidance on this expensive and labor-intensive procedure.”

cEEG monitoring improve diagnoses and timely treatment of post-traumatic seizures:

Incidence of seizures on continuous EEG monitoring following traumatic brain injury in children

O’Neill B, Handler M, Tong S, et al, 2015

“Continuous EEG monitoring identifies a significant number of subclinical seizures acutely after traumatic brain injury (TBI). Children younger than 2.4 years of age and victims of abusive head trauma (AHT) are particularly vulnerable to subclinical seizures, and seizures in general. Continuous EEG monitoring allows for accurate diagnosis and timely treatment of post-traumatic seizures, and may mitigate secondary injury to the traumatized brain.”

cEEG monitoring is gaining popularity among providers to detect nonconvulsive seizures:

Continuous EEG monitoring: a survey of neurophysiologists and neurointensivists

Gavvala J, Abend N, LaRoche S, et al, 2014

“Continuous EEG is utilized by nearly all respondents to detect nonconvulsive seizures (NCS) in patients with altered mental status following clinical seizures, intra cerebral hemorrhage (ICH), traumatic brain injury, and cardiac arrest, as well as to characterize abnormal movements suspected to be seizures. The majority of physicians monitor comatose patients for 24-48 hours. In an ideal situation with unlimited resources, 18 percent of respondents would increase cEEG duration. Eighty-six percent of institutions have an on-call EEG technologist available 24/7 for new patient hookups, but only 26 percent have technologists available 24/7 in-house. There is substantial variability in who reviews EEG and how frequently it is reviewed as well as use of quantitative EEG.”

Continuous electrophalographic monitoring (cEEG) is a noninvasive neuromonitoring technique that detects non-convulsive seizures (NCS) and non-convulsive epilepticus (NCSE):

Pediatric ICU EEG Monitoring: Current Resources and Practice in the United States and Canada

Sanchez S, Carpenter J, Chapman K, et al, 2013

“Among the surveyed institutions, which included primarily large academic centers, cEEG use in pediatric intensive care units is increasing and is often considered indicated for children with altered mental status at risk for non-convulsive seizures. However, there remains substantial variability in cEEG access and utilization among institutions.”

cEEG can detect convulsive and nonconvulsive seizures, brain ischemia, and other disturbances as they occur:

Continuous and routine EEG in intensive care

Ney J, van der Goes D, Nuwer M, et al, 2013

“cEEG is favorably associated with inpatient survival in mechanically ventilated patients, without adding significant charges to the hospital stay…Continuous EEG (cEEG) is increasingly utilized in critically ill patients with abnormal neurologic function. cEEG can detect convulsive and nonconvulsive seizures, brain ischemia, and other disturbances as they occur, prompting adjustment of anticonvulsants or interventions to reverse focal ischemia. For seizures, only cEEG can provide this diagnostic information; for detection of focal ischemia, cEEG may be more sensitive than imaging and gives uninterrupted bedside appraisal.”