The Challenge of Non-Convulsive Seizures

Non-convulsive seizures are a neurological emergency that needs to be treated quickly to prevent brain damage. An electroencephalogram (EEG) is required to detect these seizures, but EEG systems are not designed for acute care needs

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.1

Diagnosis

  • Non-convulsive seizures are difficult to detect and often go undiagnosed because patients exhibit little to no outward clinical signs.6,7

  • Prolonged non-convulsive seizures lead to permanent brain injury.4

  • Early detection and treatment of seizures is crucial for improving patient outcomes.8,9

Guidelines

“EEG should be initiated within one hour of suspected Status Epilepticus in all patients.”

NCS Guidelines for the Evaluation and Management of Status Epilepticus10

American Heart Association

“Recommend promptly performing and interpreting EEG for the diagnosis of seizures in patients who do not follow commands after ROSC.”

AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care11,12

The Joint Commission

“Growing evidence suggests that [comprehensive post–cardiac arrest care] is critical for both patient survival and optimal neurological outcome.”

R3 Report on Resuscitation Standards for Hospitals13

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.14

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.

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

“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

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Resources

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Webinar: NCSE is a Medical Emergency & Why It Should Scare You

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NCSE and the Impact of Rapid EEG

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NCSE Is A Medical Emergency – Dr. DaiWai Olson

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References and Citations

1. Herman, S.T., et al. (2015) J Clin Neurophysiol. 32(2):87-95
2. Laccheo, I., et al. (2015) Neurocrit Care. 22:202-211
3. De Marchis, G.M., et al. (2016) Neurology. 86(3):253-260
4. Claassen, J., et al. (2004) Neurology. 62(10):1743-1748
5. Rudin, D., et al. (2011) Epilepsy Res. 96(1-2):140-150
6. Fatma, T., et al. (2016) J. King Saud Univ. – Comput. Inf. Sci. 28(4):407-415
7. Holtkamp, M., et al. (2011) Ther Adv Neurol Disord. 4(3):169-181
8. Young, G.B., et al. (1996) Neurology. 47(1):83-89

9. Lowenstein, D.H., et al. (1993) Neurology. 43(3 Pt 1): 483-488
10. Brophy, G., et al. (2012) Neurocrit Care. 17(1):3-23
11. Panchal, A.R., et al. (2020) Circulation. 142(suppl 2):S366-S468
12. Perman S.M., et al. (2023) Circulation 149(5):e254-e273
13. The Joint Commission (2021) R3 Report Resuscitation Standards for Hospitals. Issue 29
14. Gururangan, K., et al. (2016) Clinical Neurophysiology. 127(10):3335-3340
15. Vespa, P.M., et al. (2020) Crit Care Med. 48(9):1249-1257