SpringerLink
Log in

Predictors of seizure detection and EEG clinical impact in an italian tertiary emergency department

  • Original Communication
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

Background and objectives

Epileptic seizures pose challenges in emergency departments (ED), affecting up to 10% of admitted patients. This study aimed to assess emergency electroencephalogram (EmEEG) utilization, identifying factors predicting seizure detection and its influence on clinical decisions.

Methods

A retrospective review of 1135 EmEEGs on 1017 patients at a tertiary teaching hospital between June 2022 and June 2023 was conducted. Data included demographics, medical history, EmEEG indications, neuroimaging findings, and clinical outcomes. Statistical analyses utilized Fisher’s exact tests and logistic regression models.

Results

EmEEG detected status epilepticus-related seizures in 5.40% of cases, seizures without status epilepticus in 3.05%, and status epilepticus without discrete seizures in 3.74%. Epileptiform abnormalities were noted in 22.12% of EmEEGs. EmEEG influenced initial diagnoses (21.24%), antiseizure medication changes (20.85%), and discharge decisions (39.04%). Predictors for seizures/status epilepticus included previous neurosurgery, seizures in the ED, and cognitive/behavioral impairment (p < 0.001). EmEEG significantly altered initial diagnoses based on witnessed seizures, involuntary movements, epileptiform abnormalities, and 1–2 Hz generalized periodic discharges (p < 0.001). Changes in antiseizure medications correlated with seizure occurrence, neuroimaging results, epileptiform abnormalities, and EEG background slowing (p < 0.001). Factors influencing discharge decisions included previous neurosurgery, consciousness impairment, acute neuroimaging pathology, EEG focal slowing, and EEG background slowing (p < 0.001).

Discussion

The study clarifies EmEEG's role in modifying initial diagnoses, treatment approaches, and discharge decisions. The study provides insights into the nuanced impact of EmEEG in different clinical scenarios, offering valuable guidance for clinicians in selecting patients for EmEEG, particularly in conditions of limited EEG availability.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price includes VAT (Germany)

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

The data sets generated during and/or analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request.

References

  1. Johnson J, Sims R, Gottlieb G (1994) Differential diagnosis of dementia, delirium and depression Implications for drug therapy. Drugs Aging 5:431–445

    Article  CAS  PubMed  Google Scholar 

  2. Erkinjuntti T, Wikström J, Palo J, Autio L (1986) Dementia among medical inpatients. Evaluation of 2000 consecutive admissions. Arch Intern Med. 146:1923–1926

    Article  CAS  PubMed  Google Scholar 

  3. Wofford JL, Loehr LR, Schwartz E (1996) Acute cognitive impairment in elderly ED patients: etiologies and outcomes. Am J Emerg Med. 14:649–653

    Article  CAS  PubMed  Google Scholar 

  4. Hauser WA, Rich SS, Annegers JF, Anderson VE (1990) Seizure recurrence after a 1st unprovoked seizure: an extended follow-up. Neurology 40:1163–1170

    Article  CAS  PubMed  Google Scholar 

  5. Fisher RS, Acevedo C, Arzimanoglou A et al (2014) ILAE official report: a practical clinical definition of epilepsy. Epilepsia 55:475–482

    Article  PubMed  Google Scholar 

  6. Quigg M, Shneker B, Domer P (2001) Current practice in administration and clinical criteria of emergent EEG. J Clin Neurophysiol 18:162–165

    Article  CAS  PubMed  Google Scholar 

  7. Varelas PN, Spanaki MV, Hacein-Bey L, Hether T, Terranova B (2003) Emergent EEG: indications and diagnostic yield. Neurology 61:702–704

    Article  CAS  PubMed  Google Scholar 

  8. Praline J, de Toffol B, Mondon K et al (2004) Emergency EEG: actual indications and results. Neurophysiol Clin. 34:175–181

    CAS  PubMed  Google Scholar 

  9. Primavera A, Audenino D, Cocito L (2004) Emergent EEG: indications and diagnostic yield. Neurology 62:1029 (Author reply 1029)

    Article  PubMed  Google Scholar 

  10. Bauer G, Trinka E (2010) Nonconvulsive status epilepticus and coma. Epilepsia 51:177–190

    Article  PubMed  Google Scholar 

  11. Towne AR, Waterhouse EJ, Boggs JG et al (2000) Prevalence of nonconvulsive status epilepticus in comatose patients. Neurology 54:340–345

    Article  CAS  PubMed  Google Scholar 

  12. Privitera M, Hoffman M, Moore JL, Jester D (1994) EEG detection of nontonic-clonic status epilepticus in patients with altered consciousness. Epilepsy Res 18:155–166

    Article  CAS  PubMed  Google Scholar 

  13. Bleck TP (1999) Management approaches to prolonged seizures and status epilepticus. Epilepsia. 40(Suppl 1):S59–S63

    PubMed  Google Scholar 

  14. Treiman DM (1993) Generalized convulsive status epilepticus in the adult. Epilepsia 34(Suppl 1):S2-11

    PubMed  Google Scholar 

  15. Firosh Khan S, Ashalatha R, Thomas SV, Sarma PS (2005) Emergent EEG is helpful in neurology critical care practice. Clin Neurophysiol 116:2454–2459

    Article  CAS  PubMed  Google Scholar 

  16. ACEP Clinical Policies Committee Clinical Policies Subcommittee on Seizures (2004) Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with seizures. Ann Emerg Med. 43:605–625

    Article  Google Scholar 

  17. Hirsch LJ, LaRoche SM, Gaspard N et al (2013) American clinical neurophysiology society’s standardized critical care EEG terminology: 2012 version. J Clin Neurophysiol 30:1–27

    Article  CAS  PubMed  Google Scholar 

  18. Herman ST, Abend NS, Bleck TP et al (2015) Consensus statement on continuous EEG in critically ill adults and children, part I: indications. J Clin Neurophysiol 32:87–95

    Article  PubMed  PubMed Central  Google Scholar 

  19. Vespignani H, Ducrocq X, Schaff JL (1997) Indications for emergency EEG in disease, a brief loss of consciousness in generalized epileptic seizures in the adult. Neurophysiol Clin. 27:390–39

    Article  CAS  PubMed  Google Scholar 

  20. de Toffol B, Hommet C, Corcia P, Autret A (1997) Indications for emergency EEG. Focal neurologic deficits and partial epileptic seizures in adults. Neurophysiol Clin. 27:383–389

    Article  PubMed  Google Scholar 

  21. Legros B, Fournier P, Chiaroni P et al (1998) Emergency EEG and brain injuries. Neurophysiol Clin. 28:111–120

    Article  CAS  PubMed  Google Scholar 

  22. Eurostat. EU median age increased by 2.3 years since 2013 [online]. 2024. Accessed at: https://ec.europa.eu/eurostat/en/web/products-eurostat-news/w/ddn-20240215-1.

  23. Ziai WC, Schlattman D, Llinas R et al (2012) Emergent EEG in the emergency department in patients with altered mental states. Clin Neurophysiol 123:910–917

    Article  PubMed  Google Scholar 

  24. Rodríguez Quintana JH, Bueno SJ, Zuleta-Motta JL, Ramos MF, Vélez-van-Meerbeke A, The Neuroscience Research Group (NeuRos) (2021) Utility of routine EEG in emergency department and inpatient service. Neurol Clin Pract. 11:e677–e681

    Article  PubMed  PubMed Central  Google Scholar 

  25. Schreiner A, Pohlmann-Eden B (2003) Value of the early electroencephalogram after a first unprovoked seizure. Clin Electroencephalogr 34:140–144

    Article  CAS  PubMed  Google Scholar 

  26. Hui AC, Tang A, Wong KS, Mok V, Kay R (2001) Recurrence after a first untreated seizure in the Hong Kong Chinese population. Epilepsia 42:94–97

    Article  CAS  PubMed  Google Scholar 

  27. King MA, Newton MR, Jackson GD et al (1998) Epileptology of the first-seizure presentation: a clinical, electroencephalographic, and magnetic resonance imaging study of 300 consecutive patients. Lancet 352:1007–1011

    Article  CAS  PubMed  Google Scholar 

  28. Paliwal P, Wakerley BR, Yeo LLL et al (2015) Early electroencephalography in patients with emergency room diagnoses of suspected new-onset seizures: diagnostic yield and impact on clinical decision-making. Seizure 31:22–26

    Article  PubMed  Google Scholar 

  29. Krumholz A, Wiebe S, Gronseth G et al (2007) Practice parameter: evaluating an apparent unprovoked first seizure in adults (an evidence-based review): report of the quality standards subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology 69:1996–2007

    Article  CAS  PubMed  Google Scholar 

  30. Wiebe S, Téllez-Zenteno JF, Shapiro M (2008) An evidence-based approach to the first seizure. Epilepsia 49(Suppl 1):50–57

    Article  PubMed  Google Scholar 

  31. Teleb MS, Lee SW, Crepeau AZ et al (2012) Cross section of stat (emergent) EEG use. Who orders them? What do we find? What indications best predict finding seizures? Neurodiagn J. 52:281–290

    PubMed  Google Scholar 

Download references

Funding

This study received no funding.

Author information

Authors and Affiliations

  1. Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy

    Anna Bellini, Davide Gusmeo Curti, Giordano Cecchetti, Federica Agosta, Giovanna F. Fanelli & Massimo Filippi

  2. Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Anna Bellini, Davide Gusmeo Curti, Marco Cursi, Giordano Cecchetti, Giovanna F. Fanelli & Massimo Filippi

  3. Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Giordano Cecchetti, Federica Agosta & Massimo Filippi

  4. Vita-Salute San Raffaele University, Milan, Italy

    Davide Gusmeo Curti, Federica Agosta & Massimo Filippi

  5. Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Massimo Filippi

Authors
  1. Anna Bellini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Davide Gusmeo Curti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marco Cursi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Giordano Cecchetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Federica Agosta
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Giovanna F. Fanelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Massimo Filippi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Massimo Filippi.

Ethics declarations

Conflict of interest

A. Bellini has received speaker honoraria from Angelini Pharma. G. Cecchetti has received speaker honoraria from Neopharmed Gentili. F. Agosta is Associate Editor of NeuroImage: Clinical, has received speaker honoraria from Biogen Idec, Italfarmaco, Roche, Zambon and Eli Lilly, and receives or has received research supports from the Italian Ministry of Health, the Italian Ministry of University and Research, AriSLA (Fondazione Italiana di Ricerca per la SLA), the European Research Council, the EU Joint Programme—Neurodegenerative Disease Research (JPND), and Foundation Research on Alzheimer Disease (France). M. Filippi is Editor-in-Chief of the Journal of Neurology, Associate Editor of Human Brain Map**, Neurological Sciences, and Radiology; received compensation for consulting services from Alexion, Almirall, Biogen, Merck, Novartis, Roche, Sanofi; speaking activities from Bayer, Biogen, Celgene, Chiesi Italia SpA, Eli Lilly, Genzyme, Janssen, Merck-Serono, Neopharmed Gentili, Novartis, Novo Nordisk, Roche, Sanofi, Takeda, and TEVA; participation in Advisory Boards for Alexion, Biogen, Bristol-Myers Squibb, Merck, Novartis, Roche, Sanofi, Sanofi-Aventis, Sanofi-Genzyme, Takeda; scientific direction of educational events for Biogen, Merck, Roche, Celgene, Bristol-Myers Squibb, Lilly, Novartis, Sanofi-Genzyme; he receives research support from Biogen Idec, Merck-Serono, Novartis, Roche, the Italian Ministry of Health, the Italian Ministry of University and Research, and Fondazione Italiana Sclerosi Multipla. Other authors have nothing to disclose.

Ethical approval

Local ethical standards committee on human experimentation approved the study protocol, which has been performed in accordance with the ethical standards of the 1964 Declaration of Helsinki. Moreover, all participants provided written informed consent prior to study inclusion.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bellini, A., Curti, D.G., Cursi, M. et al. Predictors of seizure detection and EEG clinical impact in an italian tertiary emergency department. J Neurol (2024). https://doi.org/10.1007/s00415-024-12464-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00415-024-12464-4

Keywords

Search

Navigation