Full member of ERN EpiCARE, Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.
Department of Neurology, University Hospital Regensburg, Regensburg, Germany.
PLoS One. 2024 Oct 31;19(10):e0310223. doi: 10.1371/journal.pone.0310223. eCollection 2024.
In the neurological emergency room (nER), timely electroencephalography (EEG) diagnostic is often crucial in patients with altered state of consciousness as well as in patients presenting with a first seizure. Yet, routine-EEG (rEEG) is often not available, especially during off-hours.
We analyzed the value of a commercially available, simplified wireless eight-channel EEG recording (swEEG, CerebAir® EEG headset, Nihon Kohden), applied by non-EEG-specialized medical students, in patients presenting in our nER with (suspicion of) epileptic seizures and/or loss of or altered state of consciousness between 08/2019 and 08/2022. We evaluated the feasibility and validity compared to a standard rEEG (21 electrodes according to the international 10/20 system) and also included the clinical follow-up of the patients.
100 patients were included in our analysis (mean age 57.6 ± 20.4 years; 61 male). Median time of electrode application was 7 minutes (range 4-20 minutes), with significantly longer duration in patients with altered level of consciousness (median 8 minutes, p = 0.035). Electrode impedances also differed according to state of consciousness (p = 0.032), and were higher in females (p<0.001). 55 patients received additional rEEG, either during their acute nER stay (25) and/or during the next days (38). Considering normal EEG findings vs. pathological slowing vs. epileptiform activity, swEEG matched first rEEG results in 48/55 cases (87.3%). Overall, swEEG detected the same or additional pathological EEG patterns in 52/55 cases (94.5%). In 7/75 patients (9.3%) who did not receive rEEG, or had their rEEG scheduled to a later time point during their hospital stay, swEEG revealed important additional pathological findings (e.g. status epilepticus, interictal epileptiform discharges), which would have triggered acute therapeutic consequences or led to further diagnostics and investigations.
The introduced swEEG represents a practicable, valuable technique to be quickly applied by non-EEG-specialized ER staff to initiate timely diagnostic and guide further investigations and treatment in the nER. Moreover, it may help to avoid under-diagnostic with potentially harmful consequences caused by skipped or postponed regular 10/20 EEG examinations, and ultimately improve the outcome of patients.
在神经急症室（nER）中，对于意识状态改变的患者以及首次发作的患者，及时进行脑电图（EEG）诊断通常至关重要。然而，常规脑电图（rEEG）通常无法获得，尤其是在非工作时间。
我们分析了一种商业上可用的简化无线八通道脑电图记录（swEEG，CerebAir®脑电图耳机，尼高肯）在 2019 年 8 月至 2022 年 8 月期间在我们的 nER 中出现疑似癫痫发作和/或意识丧失或改变的患者中的应用价值。我们评估了与标准 rEEG（根据国际 10/20 系统的 21 个电极）相比的可行性和有效性，还包括患者的临床随访。
我们的分析纳入了 100 名患者（平均年龄 57.6 ± 20.4 岁；61 名男性）。电极应用的中位时间为 7 分钟（范围 4-20 分钟），意识状态改变的患者的持续时间明显更长（中位数 8 分钟，p = 0.035）。电极阻抗也根据意识状态而有所不同（p = 0.032），女性更高（p<0.001）。55 名患者接受了额外的 rEEG，要么在急性 nER 住院期间（25 名），要么在接下来的几天内（38 名）。考虑到正常脑电图发现与病理性减速与癫痫样活动相比，swEEG 在 48/55 例（87.3%）病例中与首次 rEEG 结果相符。总的来说，swEEG 在 52/55 例（94.5%）病例中检测到相同或额外的病理性 EEG 模式。在 7/75 名（9.3%）未接受 rEEG 或其 rEEG 安排在住院期间的稍后时间点的患者中，swEEG 显示出重要的额外病理性发现（例如，癫痫持续状态，发作间期癫痫样放电），这将引发急性治疗后果或导致进一步的诊断和研究。
引入的 swEEG 是一种实用且有价值的技术，可由非脑电图专业的急诊室工作人员快速应用，以在 nER 中及时进行诊断，并指导进一步的调查和治疗。此外，它可以帮助避免因跳过或推迟常规 10/20 EEG 检查而导致的诊断不足，从而潜在地造成有害后果，并最终改善患者的预后。
