Comparing Seizures Captured by Rapid Response EEG and Conventional EEG Recordings in a Multicenter Clinical Study.

OBJECTIVE

A recent multicenter prospective study (DECIDE trial) examined the use of Ceribell Rapid Response EEG () in the emergent evaluation and management of critically ill patients suspected to have non-convulsive seizures. We present a detailed, patient-level examination of seizures detected either on initial or subsequent conventional EEG within 24 h to investigate whether seizures were missed on due to the exclusion of midline/parasagittal coverage.

METHODS

We identified from 164 patients studied in the DECIDE trial those who had seizures detected on but not conventional EEG ( = 6), conventional EEG but not ( = 4), or both and conventional EEG ( = 9). We examined the electrographic characteristics of ictal and interictal findings on both devices, especially their detection in lateral or midline/parasagittal chains, and patient clinical histories to identify contributors toward discordant seizure detection.

RESULTS

Seizures detected on both EEG systems had similar electrographic appearance and laterality. Seizures detected only on conventional EEG (within 24 h following ) were visible in the temporal chains, and external clinical factors (e.g., treatment with anti-seizure medications, sedation, and duration of recordings) explained the delayed presentation of seizures. Patients with seizures detected only by were treated with anti-seizure medications, and subsequent conventional EEG detected interictal highly epileptiform patterns with similar laterality.

CONCLUSIONS

Our case series demonstrates that electrographic data obtained from initial and subsequent conventional EEG monitoring are largely concordant relative to morphology and laterality. These findings are valuable to inform future investigation of abbreviated EEG systems to optimize management of suspected non-convulsive seizures and status epilepticus. Future, larger studies could further investigate the value of findings for forecasting and predicting seizures in long-term EEG recordings.