1 / 20

STAT ( Ememgent ) EEGs

STAT ( Ememgent ) EEGs. Nonconvulsive Status Epilepticus. Emergency – pathological condition which is life threatening or which can lead to organ failure requiring prompt treatment in order to avoid severe worsening and/or severe sequels. STAT. From Latin statim - immediately. Problems.

maille
Download Presentation

STAT ( Ememgent ) EEGs

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. STAT (Ememgent) EEGs Nonconvulsive Status Epilepticus

  2. Emergency – pathological condition which is life threatening or which can lead to organ failure requiring prompt treatment in order to avoid severe worsening and/or severe sequels Neurophysiologie Clinique 1998

  3. STAT • From Latin statim- immediately

  4. Problems • Poor use of time and resources • Detriment of patients who really need stat procedures • Increased turnaround time of non-STAT procedures • Staffing difficulties • Increasing use of overtime • Frustration and strain on staff and physicians • STAT EEG is not like STAT EKG Benbadis 2008

  5. Performed emergently • Interpreted emergently • Acted upon emergently

  6. 256 emegent EEGs (total 2798 EEGs) • Useful helped in diagnosis, therapy or exclusion of specific condition • Corroborative • Not useful Khan et al., Clin Neurophysiol 2005

  7. Epilepsy related indictions(status epilepticus and followup, recurrent seizures, nonconvulsive status) – 93% useful • Other conditions – 52.6% useful Khan et al., Clin Neurophysiol., 2005

  8. 111 consecutive eEEGs • Change in treatment – 37.8% Praline et al. 2007

  9. 32 emergent pediatric EEGs (1.8 % of total) • Useful in decision making 30/32 (94 %) • Neurologist approved all of studies Kothare et al. J Child Neurol 2005

  10. Comparison of NCSE (12) and non-NCSE (36) • Duration of symptoms • Remote risk factors* • Recent risk factors • Tonic-clonic activity in current episode • History of epilepsy • Mental state/Glasgow coma scale* • Ocular movement abnormalities* • Subtle motor abnormalities Husain et al., JNNP 2002

  11. Remote risk factors • Previous stroke • Previous neurosurgery • Tumor • Dementia • Meningitis Husain et al. JNNP 2002

  12. Eye movement abnormalities • Nystagmoid eye jerks • Hippus • Repeated blinking • Persistent eye deviation Husain et al., JNNP 2002

  13. Husain et al. JNNP 2002

  14. 78 emergent EEGs • 8 NCSE • Risk factors • History of epilepsy • Observed GTCS • Seizure-like motor activity R. Khan, J Natl Med Assn, 2001

  15. All patients (8) with NCSE had at least one risk factor • 35 patients had at least one risk factor • 43 patients had no risk factors – none had NCSE R. Khan et al, J Natl Med Assn,2001

  16. Seizure like motor activity • Myoclonus • Nystagmoid eye movements • Eyelid fluttering • Conjugate eye deviations • Focal or multifocal twitching of the extremities R. Khan, J Natl Med Assn, 2001

  17. Patients with “seizure like” motor activity • 10 – EEG slowing (nonspecific) • 1 - NCSE R. Khan, J. Natl Med Assn

  18. HUP study • 152 patients to characterize specific events • Seizure incidence 31% • 363 patients with altered mental status • Seizure incidence 29%

  19. Majority of movements in ICU are non-epileptic • Facial and eye twitching high correlate with seizure activity

  20. 52 cEEG studies for “possible seizures” • 14 (27%) had epileptic seizures • 38 (73%) had non-epileptic events • Tremor • Myoclonus • Slow semi-purposeful movements • Miscellaneous Benbadis, Epilepsia, 2010

More Related