ArticleEpilepsia open2022
Risk factors that predict delayed seizure detection on continuous electroencephalogram (cEEG) in a large sample size of critically ill patients.
Article in Epilepsia open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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8 citing papers in PubMed, 14 citations in OpenAlex.
- EEG in the Emergency Department: When the Neurophysiological Test Can Be Avoided in Emergency Diagnostic Workups? The EMINENCE Study.Neurology international · 2026Article
- Duration of EEG monitoring needed to ensure a low risk of seizure recurrence in hospitalized patients.Journal of neurology · 2026Article
- Contribution of the EEG in the Diagnostic Workup of Patients with Transient Neurological Deficit and Acute Confusional State at the Emergency Department: The EMINENCE Study.Diagnostics (Basel, Switzerland) · 2025Article
- The role of EEG in the emergency department: Its contribution to the patient's diagnostic-therapeutic pathway. The EMINENCE study.Clinical neurophysiology practice · 2025Article
- The Role of Routine Electroencephalography in the Diagnosis of Seizures in Medical Intensive Care Units.Diagnostics (Basel, Switzerland) · 2024Article
- Prevalence of non-convulsive seizures and electroencephalographic abnormalities in critically ill patients-A retrospective observational study.Epilepsia open · 2024Observational
- Targeted continuous EEG monitoring in critically ill patients: The long and the short of a scalability problem.Epilepsia open · 2023Article
- Risk factors that predict delayed seizure detection on continuous electroencephalogram (cEEG) in a large sample size of critically ill patients.Epilepsia open · 2022Article
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3 authors at 2 institutions in 1 country.
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No grant is acknowledged in the PubMed record.
Abstract
objectiveMajority of seizures are detected within 24 hours on continuous EEG (cEEG). Some patients have delayed seizure detection after 24 hours. The purpose of this research was to identify risk factors that predict delayed seizure detection and to determine optimal cEEG duration for various patient subpopulations.
methodsWe retrospectively identified all patients ≥18 years of age who underwent cEEG at Cleveland clinic during calendar year 2016. Clinical and EEG data for all patients and time to seizure detection for seizure patients were collected.
resultsTwenty-four hundred and two patients met inclusion criteria. Of these, 316 (13.2%) had subclinical seizures. Sixty-five (20.6%) patients had delayed seizures detection after 24 hours. Seizure detection increased linearly till 36 hours of monitoring, and odds of seizure detection increased by 46% for every additional day of monitoring. Delayed seizure risk factors included stupor (13.2% after 48 hours, P = .031), lethargy (25.9%, P = .013), lateralized (LPDs) (27.7%, P = .029) or generalized periodic discharges (GPDs) (33.3%, P = .022), acute brain insults (25.5%, P = .036), brain bleeds (32.8%, P = .014), especially multiple concomitant bleeds (61.1%, P < .001), altered mental status (34.7%, P = .001) as primary cEEG indication, and use of antiseizure medications (27.8%, P < .001) at cEEG initiation. SIGNIFICANCE: Given the linear seizure detection trend, 36 hours of standard monitoring appears more optimal than 24 hours especially for high-risk patients. For awake patients without epileptiform discharges, <24 hours of monitoring appears sufficient. Previous studies have shown that coma and LPDs predict delayed seizure detection. We found that stupor and lethargy were also associated with delayed seizure detection. LPDs and GPDs were associated with delayed seizures. Other delayed seizure risk factors included acute brain insults, brain bleeds especially multiple concomitant bleeds, altered mental status as primary cEEG indication, and use of ASMs at cEEG initiation. Longer cEEG (≥48 hours) is suggested for these high-risk patients.
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