Rapid EEG Monitoring in Clinical Practice

Rapid electroencephalography (EEG) devices have emerged in response to the growing awareness of seizures and highly epileptiform patterns in critically ill patients and limitations associated with conventional EEG infrastructure. In this review, we describe rapid EEG utilization patterns, clinical workflows, implementation challenges, and financial considerations using a narrative review supplemented by a multi-institutional survey of 20 centers affiliated within the Critical Care EEG Monitoring Research Consortium. We identified that rapid EEG was perceived to expedite diagnosis and treatment decisions and enhance clinical triage, and most respondents perceived the cost of rapid EEG sessions to be low. However, commonly cited limitations included lower spatial resolution and unsuitability for replacing conventional EEG for prolonged monitoring. Prior cohort studies and clinical trials of rapid EEG devices display site-by-site variability in practical workflows regarding specificity of clinical indications for monitoring and designated personnel for device setup and EEG review, however, rapid EEG was reported to consistently augment EEG monitoring capabilities even at centers with access to conventional EEG. Because rapid EEG devices are increasingly adopted, and paired with artificial intelligence tools, it will be vital for institutions to develop protocols and guidelines with multidisciplinary input to steer their responsible, effective, and sustainable use.