The Challenge of Non-Convulsive Seizures

Dr. Bleck discusses the importance of rapidly applying EEG to obtain a diagnosis and treat non-convulsive status epilepticus quickly

“Mortality disability increase if the seizure is allowed to continue, and unless you do an EEG of some sort, you don’t know. We should really be attaching an EEG to the patient very quickly.”

DR. THOMAS P. BLECK
Founding President of Neurocritical Care Society

Prevalence

Non-convulsive seizures, including cases of non-convulsive status epilepticus (NCSE), are common in critically ill patients in emergency departments and intensive care units.^42,55

2. Diagnosis

Non-convulsive seizures are difficult to detect and often go undiagnosed because patients exhibit little to no outward clinical signs.^71,72
Prolonged non-convulsive seizures lead to permanent brain injury.⁵⁵
Early detection and treatment of seizures is crucial for improving patient outcomes.^30,62

3. Guidance

“EEG should be initiated within 15-60 minutes of suspected Status Epilepticus in all patients.”

Guidelines for the Evaluation and Management of Status Epilepticus. Neurocritical Care. 2012 Aug;17(1):3-23.

4. Conventional EEG Results in 4-60 Hours

EEG services often rely on a few key personnel, which makes emergency requests difficult – especially after hours. Without an EEG result, over-treatment can lead to increased sedation, prolonged length of stay, and unnecessary intubations while under-treatment can lead to prolonged seizures, increased length of hospital stay, and worse prognosis.⁴⁶

CURRENT EEG PRACTICE:

EEG is not widely available across hospitals, and where it is available, there can be delays of hours or even days before it can be administered.
Setup and workflow is complicated.
The conventional EEG system is not designed for speed; recording and reading an EEG is complex and slow.
A specialized technician is required to connect electrodes to the scalp, set up the system, and record.
Once the EEG data is collected, a trained EEG specialist is needed to interpret the recordings and relay the diagnostic information to physicians in the ICU and emergency department.