Continuous EEG use and status epilepticus treatment in Australasia: a practice survey of Australian and New Zealand epileptologists

Abstract

ObjectiveContinuous electroencephalography (cEEG) is increasingly used to detect non-convulsive seizures in critically ill patients but is not widely practised in Australasia. Use of cEEG is also influencing the management of status epilepticus (SE), which is rapidly evolving. We aimed to survey Australian and New Zealand cEEG use and current treatment of SEMethodsA web-based survey was distributed to Epilepsy Society of Australia (ESA) members, between October and November 2019. Adult and paediatric neurologists/epileptologists with ESA membership involved in clinical epilepsy care and cEEG interpretation were invited to participate.ResultsThirty-five paediatric/adult epileptologists completed the survey, 51% with over 10 years of consultant experience. cEEG was always available for only 31% of respondents, with the majority having no or only ad hoc access to cEEG. Lack of funding (74%) and personnel (71%) were the most common barriers to performing cEEG. Although experience with SE was common, responses varied regarding treatment approaches for both convulsive and non-convulsive SE. Escalation to anaesthetic treatment of convulsive SE tended to occur later than international guideline recommendations. There was general agreement that formal training in cEEG and national guidelines for SE/cEEG were needed.ConclusionscEEG availability remains limited in Australia, with lack of funding and resourcing being key commonly identified barriers. Current opinions on the use of cEEG and treatment of SE vary reflecting the complexity of management and a rapidly evolving field. An Australian-based guideline for the management of SE, including the role of cEEG is recommended.

Continuous electroencephalography in the intensive care unit: A critical review and position statement from an Australian and New Zealand perspective

“…Conversely, episodic nonepileptic movements and autonomic changes in ICU patients are commonly misinterpreted and unnecessarily treated as seizures, prolonging ICU stay and impacting adversely on outcome. [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] …”

“…cEEG is not utilised routinely in ICUs in Australia and New Zealand (ANZ), unlike in North America and many centres in Europe. 1 The availability of inpatient EEG services varies around our countries, particularly between city and rural, and paediatric and adult hospitals. Impediments to cEEG in ANZ include the following: it is a resource- and time-intensive investigation, well-trained staff members to perform and interpret cEEG in a timely fashion are few, the clinical significance of some cEEG findings remains uncertain, the cost-effectiveness of cEEG and treatment of ESz remains to be demonstrated, and specific financial reimbursement is lacking.…”