Electroencephalography during SARS-CoV-2 outbreak: practical recommendations from the task force of the Italian Society of Neurophysiology (SINC), the Italian League Against Epilepsy (LICE), and the Italian Association of Neurophysiology Technologists (AITN)

Abstract

Background During COVID-19 lockdown, non-urgent medical procedures were suspended. Grade of urgency of electroencephalography (EEG) may vary according to the clinical indication, setting, and status of infection of SARS-CoV-2 virus. "Italian Society of Clinical Neurophysiology" (SINC), "Italian League Against Epilepsy" (LICE), and the "Italian Association of Neurophysiology Technologists" (AITN) aimed to provide clinical and technical recommendation for EEG indications and recording standards in this pandemic era. Methods Presidents of SINC, LICE, and AITN endorsed three members per each society to formulate recommendations: classification of the degree of urgency of EEG clinical indications, management and behavior of physicians and neurophysiology technologists, hygiene and personal protection standards, and use of technical equipment. Results Scientific societies endorsed a paper conveying the recommendation for EEG execution in accordance with clinical urgency, setting (inpatients/outpatients), status of SARS-CoV-2 virus infection (positive, negative and uncertain), and phase of governmental restrictions (phase 1 and 2). Briefly, in phase 1, EEG was recommended only for those acute/subacute neurological symptoms where EEG is necessary for diagnosis, prognosis, or therapy. Outpatient examinations should be avoided in phase 1, while they should be recommended in urgent cases in phase 2 when they could prevent an emergency room access. Reduction of staff contacts must be encouraged through rescheduling job shifts. The use of disposable electrodes and dedicated EEG devices for COVID-19-positive patients are recommended. Conclusions During the different phases of COVID-19 pandemic, the EEG should be reserved for patients really benefiting from its execution in terms of diagnosis, treatment, prognosis, and avoidance of emergency room access.

Electroencephalography at the time of Covid-19 pandemic in Italy

“…Unfortunately, the indication for EEG was provided not only by neurologists but also by emergentists, intensivists, general practitioners and other specialists. In accordance with International [9] and the only recently published Italian recommendations (www.lice.it; www.sinc-italia.it; www.aitn.it; not available at the moment of the present questionnaire publication) [10], we think that this approach to EEG's prescription executed by a non-neurologist is not a good clinical practice considering the need of reducing the total number of the EEG and of limiting its recording to the only urgent cases. Actually, since the beginning of the emergency period, international [1] and Italian governmental agencies [11] recommended the suspension of all elective and "non-urgent" procedures, including radiological tests, surgery, and neurophysiological exams.…”

An Assessment of the Novel COVISTRESS Questionnaire: COVID-19 Impact on Physical Activity, Sedentary Action and Psychological Emotion

“…In Scotland, the financial impact of COVID-19 has been supported by the Scottish Government with a goal to protect and secure their world-leading research programmes through the provision of a £75 million one-off increase in funding for Scotland’s universities [ 10 ]. More recently, various independent and collaborative multidisciplinary related research studies on COVID-19 have been investigated in the area of equipment and manufacturing [ 11 , 12 , 13 , 14 ], pathophysiology [ 15 , 16 , 17 ], neurophysiology [ 18 , 19 , 20 , 21 ], radiology [ 22 , 23 , 24 , 25 ], psychology [ 26 , 27 ], diagnostics [ 28 , 29 , 30 , 31 , 32 ] and treatment [ 33 , 34 , 35 ].…”

Response to Canadian Neurophysiology Laboratory COVID-19 Practice Guidelines

“…Requiring patients to wear surgical masks will reduce the degree of hypocapnia achieved, and thus compromise the effectiveness of the provocative maneuver; other published COVID-19 literature has made the opposite recommendation, stating that hyperventilation should never be performed with a mask. [3][4][5] I was curious as to what evidence supported the CJNS guideline, so I reviewed the three citations given by the authors to support the statement. this very conservative document makes the somewhat confusing statement "Avoid maneuvers that promote airway handling.…”

“…While I understand the rush to publish quickly, this sort of misleading citation practice calls into question the reliability of the guidelines, particularly as the authors did not acknowledge other references providing very different guidance on the issue of hyperventilation, supported by accurate citations and rational argument. [3][4][5] The decisions around hyperventilation and other neurophysiology laboratory protocols are complex, and should be based on several factors, including up-to-date local data on infection rates. For regions in which there is a very low level of community transmission, only minimal protocol changes may be necessary, and hyperventilation would seem safe in all patients without infectious symptoms or known COVID-19 contacts.…”