Status Epilepticus Is Detected Earlier than Seizures on cEEG in Critically Ill Adults

Seizure burden seems to correlate with clinical outcome in critically ill patients. Continuous electroencephalogram (cEEG) is increasingly utilized in this context but is more resource-demanding than routine EEG (rEEG). Strategies to stratify the risk of seizures on cEEG have been proposed, but the impact of seizure duration on detection latency has not been well characterized.

This is a retrospective analysis of data from the CERTA trial on critically ill adults (NCT03129438), evaluating detection latencies between recording start and short seizures (events lasting < 5 min) vs. status epilepticus [(SE) ≥ 5 min] on cEEG. Results were correlated to prognosis at 6 months (mortality and functional outcome).

Of 364 patients in the trial, 182 received cEEG. SE was detected in 16 [median latency 0 min, interquartile range (IQR) 0-552] and short seizures in 13 (median latency 375 min, IQR 54-1398; p < 0.030). Patients with seizures/SE had higher mortality (24/29 vs. 65/153, p < 0.001) but comparable functional outcome at 6 months compared with those without seizures/SE.

SE events were detected significantly earlier than short seizures. If confirmed in larger cohorts, and supported by additional data on the relationship between timely seizures/SE detection, treatment and outcome, these findings may aid in optimizing EEG resource allocation.