A reappraisal of the value of video-EEG recording in the emergency department

ABSTRACT

Introduction: Some neurologic conditions that can quickly and with low costs be recognized, classified and treated thanks to the availability of an EEG recording in an emergency setting. However, although considered a cheap, not invasive, highly accurate diagnostic investigation, still today, an EEG recording in emergency, in real time during the event paroxysmal ictal phase, is not yet been become a routine.

Areas covered: This review will cover the role and utility of EEG recording in the emergency setting, both in emergency department and intensive care unit, in adult and pediatric age, in people admitted for status epilepticus (convulsive or non-convulsive), paroxysmal non-epileptic events, or other conditions/diseases presenting with mental status changes.

Expert opinion: The prompt recognition of some specific EEG-patterns can permit an immediate and appropriate therapeutic choice with the resolution of dramatic clinical pictures, which, if not recognized, sometimes could result in severe prognostic events with high mortality or neuropsychiatric disability. It is important in the next future, to improve the availability of these EEG digital continuous monitoring, which should be widely used in emergency settings, developing moreover tools and techniques permitting also review, analysis and EEG-reporting by experts who can work away from the hospital.

KEYWORDS:

• Emergency EEG
• video-EEG
• continuous EEG
• acute differential diagnosis
• status epilepticus
• nonconvulsive status epilepticus

Article Highlights

• EEG represents the hallmark tool for the evaluation of patients with epileptic seizures or other paroxysmal non-epileptic events, change in mental status, coma and assessment of brain death. An EEG recording during the event paroxysmal ictal phase, can identify some neurologic treatable conditions.

• Sometimes, the prompt recognition of specific EEG-patterns can permit an immediate and appropriate therapeutic choice with immediate resolution of dramatic specific clinical pictures reducing, thus, high mortality rate or neuropsychiatric disability.

• Although considered a cheap, not invasive, highly accurate diagnostic investigation, an EEG recording in emergency setting is not yet been become a routine investigation.

• Particularly an ictal EEG recording is mandatory to appropriately identify and treat the various possible status epilepticus, with crucial implications particularly in pediatric age.

• In the next future, we must develop tools and techniques permitting continuous EEG monitoring in emergency setting and ICU, and also analysis and tele-EEG-reporting by experts who can work away from the hospital, on demand.

Declaration of Interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The paper was not funded.