Rapid diagnosis of pediatric nonconvulsive status epilepticus using point-of-care EEG
Leopold Simma1, Katharina Moser2, Michelle Seiler1
1Emergency Department, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland.
Insights
Point-of-care electroencephalogram (pocEEG) aids in diagnosing nonconvulsive status epilepticus (NCSE) in pediatric emergency departments. This rapid bedside tool facilitates timely recognition and treatment of NCSE, especially when standard EEG is unavailable.
Area of Science:
- Pediatric Emergency Medicine
- Neurology
- Medical Devices
Background:
- Nonconvulsive status epilepticus (NCSE) is a critical diagnosis in pediatric emergency departments (PEDs), often delayed by isolated altered mental status (AMS).
- Standard electroencephalogram (EEG) availability is limited outside regular hours, hindering timely NCSE diagnosis.
- Point-of-care EEG (pocEEG) offers a rapid, bedside alternative for recognizing NCSE.
Purpose of the Study:
- To describe the implementation and utility of a rapid, low-cost, two-channel pocEEG device in a tertiary PED.
- To evaluate pocEEG's effectiveness in diagnosing NCSE in children presenting with AMS, particularly outside standard working hours.
Main Methods:
- A quality improvement project utilizing a two-channel pocEEG device in a tertiary PED.
- Descriptive data collection focusing on children with AMS post-convulsive seizures but without apparent ongoing seizure activity.
Main Results:
- Four out of five NCSE cases were identified using pocEEG in the PED.
- All identified cases presented outside regular working hours and had received prehospital benzodiazepines.
- pocEEG revealed an ictal-interictal continuum in one case with later standard EEG confirmation of focal seizures.
Conclusions:
- pocEEG can aid in detecting NCSE in children with unexplained AMS, even without a prior seizure history.
- The pocEEG device provided a pragmatic solution for early NCSE diagnosis and treatment when standard EEG was unavailable.
- pocEEG is a valuable tool for timely seizure detection and clinical decision-making in pediatric emergency care.
Background:
Nonconvulsive status epilepticus (NCSE) is a time-critical diagnosis in children presenting to pediatric emergency departments (PEDs). Diagnostic delays are common, particularly when isolated altered mental status (AMS) is the only symptom. A standard electroencephalogram (EEG) is essential for diagnosis but rarely available outside regular working hours. Point-of-care EEG (pocEEG) is a rapid, bedside alternative that may support earlier recognition and treatment of NCSE in such situations.
Methods:
This study describes the use of a rapid, low-cost, two-channel pocEEG device during a quality improvement project at our tertiary PED. We report descriptive data of all cases, and focused on children with AMS following convulsive seizures but without apparent ongoing seizure activity.
Results:
Of 5 children diagnosed with NCSE, 4 were identified in the PED by using pocEEG. All presented outside regular working hours and had received prehospital benzodiazepines, and 4 had underlying neurological conditions. Levetiracetam was the initial intravenous in-hospital treatment in all cases; 2 required additional phenobarbital. In one case, standard EEG 23 h after presentation revealed focal seizures; retrospective review of the initial pocEEG showed an ictal-interictal continuum.
Conclusions:
Although all cases followed convulsive seizures, pocEEG may also assist in detecting NCSE in children with unexplained AMS and no seizure history. In our PED, pocEEG provided a pragmatic alternative that enabled early diagnosis and treatment of NCSE when standard EEG was unavailable. PocEEG may be a valuable tool for timely seizure detection and clinical decision-making in pediatric emergency care.
