Laing Joshua, Lawn Nicholas, Perucca Piero, Kwan Patrick, O'Brien Terence J
Neuroscience, Monash University, Melbourne, Victoria, Australia.
Epilepsy Unit, Alfred Health, Melbourne, Victoria, Australia.
BMJ Neurol Open. 2020 Dec 15;2(2):e000102. doi: 10.1136/bmjno-2020-000102. eCollection 2020.
Continuous electroencephalography (cEEG) is increasingly used to detect non-convulsive seizures in critically ill patients but is not widely practised in Australasia. Use of cEEG is also influencing the management of status epilepticus (SE), which is rapidly evolving. We aimed to survey Australian and New Zealand cEEG use and current treatment of SE.
A web-based survey was distributed to Epilepsy Society of Australia (ESA) members, between October and November 2019. Adult and paediatric neurologists/epileptologists with ESA membership involved in clinical epilepsy care and cEEG interpretation were invited to participate.
Thirty-five paediatric/adult epileptologists completed the survey, 51% with over 10 years of consultant experience. cEEG was always available for only 31% of respondents, with the majority having no or only ad hoc access to cEEG. Lack of funding (74%) and personnel (71%) were the most common barriers to performing cEEG. Although experience with SE was common, responses varied regarding treatment approaches for both convulsive and non-convulsive SE. Escalation to anaesthetic treatment of convulsive SE tended to occur later than international guideline recommendations. There was general agreement that formal training in cEEG and national guidelines for SE/cEEG were needed.
cEEG availability remains limited in Australia, with lack of funding and resourcing being key commonly identified barriers. Current opinions on the use of cEEG and treatment of SE vary reflecting the complexity of management and a rapidly evolving field. An Australian-based guideline for the management of SE, including the role of cEEG is recommended.
连续脑电图（cEEG）越来越多地用于检测重症患者的非惊厥性癫痫发作，但在澳大拉西亚地区并未广泛应用。cEEG的使用也在影响癫痫持续状态（SE）的管理，而这一管理正在迅速演变。我们旨在调查澳大利亚和新西兰cEEG的使用情况以及SE的当前治疗方法。
2019年10月至11月期间，向澳大利亚癫痫协会（ESA）成员开展了一项基于网络的调查。邀请参与临床癫痫护理和cEEG解读的成年及儿科神经科医生/癫痫专家（ESA成员）参与。
35名儿科/成人癫痫专家完成了调查，其中51%具有超过10年的顾问经验。只有31%的受访者表示始终可以使用cEEG，大多数人无法使用或只能临时使用cEEG。资金短缺（74%）和人员不足（71%）是进行cEEG检查最常见的障碍。虽然癫痫持续状态的经验很常见，但对于惊厥性和非惊厥性癫痫持续状态的治疗方法，回答各不相同。惊厥性癫痫持续状态升级为麻醉治疗的时间往往比国际指南建议的要晚。大家普遍认为需要进行cEEG的正规培训以及制定SE/cEEG的国家指南。
在澳大利亚，cEEG的可及性仍然有限，资金和资源短缺是普遍确定的关键障碍。目前关于cEEG使用和SE治疗的观点各不相同，这反映了管理的复杂性以及该领域的快速发展。建议制定一份基于澳大利亚的SE管理指南，包括cEEG的作用。
