How Point-of-Care EEG Helps Overcome Many Challenges of Acute Neurology Care

Acute care patients present a unique set of challenges for healthcare providers. Timelines for diagnosis and treatment are often compressed, and specialty expertise may not be readily available, making it even more challenging to achieve the best possible outcomes. For patients with non-convulsive seizures (NCS) and non-convulsive status epilepticus (NCSE), the stakes are particularly high. Undetected and/or prolonged seizures can lead to brain injury and increased mortality risks, yet identifying patients with potential NCS and NCSE can be challenging in fast-paced acute care environments.

Point-of-care EEG, also called rapid EEG, is a promising technology that plays a crucial role in acute neurology care by offering rapid, accessible brain monitoring, which can alert care teams to the possible presence of NCS or NCSE. While it shouldn’t always be viewed as a tool to confirm diagnoses or as a replacement for conventional EEG, point-of-care EEG offers a bridge between neurology professionals and acute care teams under heavy pressure to deliver the best possible health outcomes in the least amount of time.

Whether in the emergency department (ED) or ICU, neurology care for patients with serious injuries and illnesses can be challenging, especially when seizure symptoms are subtle. Yet the prevalence of NCS and NCSE among these patients can be high. For example, a recent study in Epilepsia Openⁱ reported that up to 20% of ICU patients experienced subclinical or nonconvulsive seizures during continuous EEG monitoring. Another study found seizures occurred in nearly a third of the critically ill patients in the cohort. ⁱⁱ

At the same time, for more than a decade physicians and other ED staff have advocatedⁱⁱⁱ for EEG to be available as a standard for acute care patients, particularly those presenting with head trauma, altered mental status (AMS), and other suspected neurology-related symptoms. In one ED study,^iv seizure activity was found in nearly 40% of patients with these symptoms. Point-of-care EEG is a way to address these needs.

Specific Challenges of Acute Neurology Care

Providing rapid access to conventional EEG can be problematic for several reasons. First, the national shortage of neurologists, neurodiagnostic technologists and technicians, and other neurology professionals may lengthen the wait for patients to begin traditional EEG monitoring. Issues with resource availability and allocation can also dramatically raise costs for EDs and ICUs. Many facilities, particularly those in rural or remote locations, lack the resources and equipment for EEG monitoring, leading to unnecessary patient transfers that can be costly, time-consuming, and even life-threatening.

Workflow inefficiencies present even more challenges for conventional EEG. EEG equipment may be too costly for a specific ICU or ED to have a dedicated unit. Even when that is not the case, space for these machines and lack of portability can also create hurdles. Potentially long waits for an EEG technician to perform the necessary tasks of applying electrodes and setting up the EEG machine can be highly disruptive to care and distressing for patients.

Set-up time, limited availability of trained staff, and a possible need for patient transport to EEG-capable facilities introduce delays that can be seriously detrimental to critically ill patients with NCS and NCSE. This can also include increased mortality risks.

Meeting Acute Neurology Care Challenges with Point-of-Care EEG (POC-EEG)

POC-EEG technology is designed to overcome these obstacles and provide faster assessment of patients with possible NCS and NCSE^v without the logistical hurdles of conventional systems. While this technology isn’t typically considered a replacement for conventional EEG, POC-EEG offers a cost-effective solution that helps non-neurology professionals rapidly and more accurately detect patients who may be experiencing seizures without obvious symptoms.

Specifically, POC-EEG can offer:

Quick Set Up: With minimal training, acute care professionals can set up and begin monitoring patients in a short amount of time. Instead of a complicated array of electrodes, POC-EEG uses a compact, portable headband that is simple to apply, delivers high-quality EEG recording, and minimizes noise interference. POC-EEG offers Bluetooth capability that can be seamlessly integrated with existing neurology workflows and comprehensive EEG software systems.

Faster Intervention: Multiple studies have indicated that the use of POC-EEG can significantly reduce the time it takes to accurately diagnose and successfully treat these patients. In an observational study published in Emergency Medicine Journal, POC-EEG was rated as useful and/or diagnostic in 92% of pediatric patient cases.^vi

It’s also important to note that newer POC-EEG technologies allow neurologists and epileptologists the ability to review POC-EEG data securely anywhere and anytime. Notably, this contributes to identifying NCS and NCSE patients more quickly, further reducing the acute care timeline and improving metrics important to EDs and ICUs.

Reduced Costs of Care: Research conducted within the ICU and EDs^vii highlight that this convenient, affordable technology can reduce overall healthcare costs in several ways, including minimizing patient transfers and decreasing hospital length-of-stay, particularly in the ED. But perhaps the greatest cost -savings may come from better resource allocation. POC-EEG is simple for ICU and ED staff to set up and perform basic monitoring, relieving the workload on EEG technicians whose time is limited. This makes it an attractive solution especially for facilities in remote or rural settings where EEG expertise is less available.

Building Trust in POC-EEG Technology

Despite its many advantages, the adoption of POC-EEG for acute neuro care has been hindered by concerns over data reliability and a lack of integration with neurology workflows. However, advancements in technology have addressed these challenges, making POC-EEG a more trusted and effective tool for neurological assessment.

The latest POC-EEG systems leverage extensive datasets that are widely trusted by neurologists and epileptologists. These systems use validated algorithms trained on trusted datasets, ensuring more accurate and reliable results that clinicians can confidently use for further analysis and intervention.
Seamless integration with existing neurology workflows further enhances the utility of POC-EEG, allowing neurologists to review results remotely in real time. Cloud-based data management solutions facilitate collaboration, ensuring that specialists can provide timely input from any location.
The latest POC-EEG devices prioritize patient comfort. Lightweight, non-invasive headbands and wireless technology make prolonged monitoring easier and more tolerable.

POC-EEG is transforming the landscape of acute neurological care by addressing critical gaps between acute care environments and neurology care. Its ability to deliver rapid, assessments of possible NCS and NCSE significantly reduces time to diagnosis and treatment, improves resource utilization, lowers costs, and ultimately leads to better patient outcomes.

As rapid EEG technology advances to become even more powerful, the use of POC-EEG within acute care settings will soon become a standard of care to ensure timely and effective neurological assessments for all patients, regardless of location or resource availability.

Sources:
i. Zawar I, Briskin I, Hantus S. Risk factors that predict delayed seizure detection on continuous electroencephalogram (cEEG) in a large sample size of critically ill patients. Epilepsia Open. 2022 Mar;7(1):131-143. doi: 10.1002/epi4.12572. Epub 2021 Dec 23. PMID: 34913615; PMCID: PMC8886063.
ii. Westover, M. Brandon, et al. “The Probability of Seizures during EEG Monitoring in Critically Ill Adults.” Clinical Neurophysiology, vol. 126, no. 3, Mar. 2015, pp. 463–471, https://doi.org/10.1016/j.clinph.2014.05.037.
iii. Abdel Baki, S.G., Omurtag, A., Fenton, A.A. et al. The new wave: time to bring EEG to the emergency department. Int J Emerg Med 4, 36 (2011). https://doi.org/10.1186/1865-1380-4-36
iv. McKay JH, Feyissa AM, Sener U, DʼSouza C, Smelick C, Spaulding A, Yelvington K, Tatum WO. Time Is Brain: The Use of EEG Electrode Caps to Rapidly Diagnose Nonconvulsive Status Epilepticus. J Clin Neurophysiol. 2019 Nov;36(6):460-466. doi: 10.1097/WNP.0000000000000603. PMID: 31335565.
v. Privitera MD, Strawsburg RH. Electroencephalographic monitoring in the emergency department. Emerg Med Clin North Am. 1994 Nov;12(4):1089-100. PMID: 7956889.
vi. Simma L, Bauder F, Schmitt-Mechelke T Feasibility and usefulness of rapid 2-channel-EEG-monitoring (point-of-care EEG) for acute CNS disorders in the paediatric emergency department: an observational study. Emergency Medicine Journal 2021;38:919-922.
vii. Davey Z, Gupta PB, Li DR, Nayak RU, Govindarajan P. Rapid Response EEG: Current State and Future Directions. Curr Neurol Neurosci Rep. 2022 Dec;22(12):839-846. doi: 10.1007/s11910-022-01243-1. Epub 2022 Nov 25. PMID: 36434488; PMCID: PMC9702853.