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 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.”

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, CCEEG 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.”

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 R1, Hifumi T, Kawakita K, Okazaki T, Egawa S, Inoue A, Seo R, Inagaki N, Kuroda Y. 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 asked 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 DM, van Mook WN, van Kranen-Mastenbroek VH. 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.”

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

Continuous and routine EEG in intensive care. Utilization and outcomes, United States 2005–2009.

John P. Ney, MD, MPH, corresponding author David N. van der Goes, PhD, Marc R. Nuwer, MD, PhD, Lonnie Nelson, PhD, and Matthew A. Eccher, MD, MSPH 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.”

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

Continuous EEG monitoring: a survey of neurophysiologists and neurointensivists.

Gavvala J1, Abend N, LaRoche S, Hahn C, Herman ST, Claassen J, Macken M, Schuele S, Gerard E; Critical Care EEG Monitoring Research Consortium (CCEMRC). 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.”

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 BR, Handler MH, Tong S, Chapman KE,2. 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.”