Rapid Response EEG: Current State and Future Directions

Abstract

Purpose of Review To critically appraise the literature on the application, methods, and advances in emergency electroencephalography (EEG). Recent Findings The development of rapid EEG (rEEG) technologies and other reduced montage approaches, along with advances in machine learning over the past decade, has increased the rate and access to EEG acquisition. These achievements have made EEG in the emergency setting a practical diagnostic technique for detecting seizures, suspected nonconvulsive status epilepticus (NCSE), altered mental status, stroke, and in the setting of sedation. Summary Growing evidence supports using EEG to expedite medical decision-making in the setting of suspected acute neurological injury. This review covers approaches to acquiring EEG in the emergency setting in the adult and pediatric populations. We also cover the clinical impact of this data, the time associated with emergency EEG, and the costs of acquiring EEG in these settings. Finally, we discuss the advances in artificial intelligence for rapid electrophysiological interpretation.

Integrating Neuromonitoring in Pediatric Emergency Medicine: Exploring Two Options for Point-of-Care Electroencephalogram (pocEEG) via Patient Monitors—A Technical Note

“…A recent review on reduced montage, rapid response EEG approaches, which includes the precursor of the presented set up, concluded that these technologies are promising and can lead to a cost-effective solutions for neuromonitoring with reduced dependence on expert staff [ 14 ]. Nonetheless, there are still several research questions that need to be addressed through future studies.…”

“…Under ideal conditions, neuromonitoring is performed in specialized centers via continuous or frequent intermittent EEG recordings, as well as through the interpretation of qualitative trends deriving from processed EEGs, such as the amplitude-integrated EEG: aEEG, in (predominantly neonatal) intensive care units [ 13 ]. However, long latencies to standard EEG initiation, even during regular working hours, have hindered its use for this indication, and have triggered the development of rapid emergent EEGs with reduced electrode montages [ 14 ]. Various commercial devices developed specifically for this purpose have been implemented and studied in adults [ 14 ], but none of them has been tested in children.…”

“…However, long latencies to standard EEG initiation, even during regular working hours, have hindered its use for this indication, and have triggered the development of rapid emergent EEGs with reduced electrode montages [ 14 ]. Various commercial devices developed specifically for this purpose have been implemented and studied in adults [ 14 ], but none of them has been tested in children. Emergent and promising simplified EEG recording setups, such as the point-of-care EEG (pocEEG), may successfully bridge latencies to standard EEG initiation in the emergency department (ED).…”