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Does Continuous Video-EEG in Patients With Altered Consciousness Improve Patient Outcome? Current Evidence and Randomized Controlled Trial Design

Rossetti, Andrea O.*; Schindler, Kaspar; Alvarez, Vincent*,‡; Sutter, Raoul§,║; Novy, Jan*; Oddo, Mauro; Warpelin-Decrausaz, Loane#; Rüegg, Stephan

Journal of Clinical Neurophysiology: September 2018 - Volume 35 - Issue 5 - p 359–364
doi: 10.1097/WNP.0000000000000467
Review Article
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Summary: Continuous video-EEG is recommended for patients with altered consciousness; as compared to routine EEG (lasting <30 minutes), it improves seizure detection, but is time- and resource-consuming. Although North American centers increasingly implement continuous video-EEG, most other (including European) hospitals have insufficient resources. Only one study suggested that continuous video-EEG could improve outcome in adults, and recent assessments challenge this view. This article reviews current evidence on the added value for continuous video-EEG in clinical terms and describes a design for a prospective study.

In a multicenter randomized clinical trial (NCT03129438), adults with a Glasgow Coma Scale ≤11 will be randomized 1:1 to continuous video-EEG (cEEG) for 30 to 48 hours or 2 routine EEG (rEEG), assessed through standardized American Clinical Neurophysiology Society (ACNS) guidelines. The primary outcome will be mortality at 6 months, assessed blindly. Secondary outcomes will explore functional status at 4 weeks and 6 months, intensive care unit (ICU) length of stay, infection rates, and hospitalization costs. Using a 2-sided approach with power of 0.8 and a error of 0.05, 2 × 174 patients are needed to detect an absolute survival difference of 14%, suggested by the single available study on the topic.

This study should help clarifying whether cEEG has a significant impact on outcome and define its cost effectiveness. If the trial will result positive, it will encourage broader implementation of cEEG with consecutive substantial impact on health care and resource allocations. If not, it may offer a rationale to design a larger trial, and – at least for smaller centers – to avoid widespread implementation of cEEG, rationalizing personnel and device costs.

*Department of Neurology, CHUV, and Université de Lausanne, Lausanne, Switzerland;

Department of Neurology, Inselspital, Bern, Switzerland;

Department of Neurology, Hôpital de Sion, and CHUV, Lausanne, Switzerland;

§Clinic for Intensive Care Medicine, University Hospital Basel, Basel, Switzerland;

Department of Neurology, University Hospital Basel, Basel, Switzerland;

Department of Adult ICU, CHUV, and Université de Lausanne, Lausanne, Switzerland; and

#Clinical Trial Unit, CHUV, and Université de Lausanne, Lausanne, Switzerland.

Address correspondence and reprint requests to Andrea O. Rossetti, MD, FAES, Service de Neurologie, CHUV-BH07, CH-1011-Lausanne, Switzerland; e-mail: andrea.rossetti@chuv.ch

The authors have no conflicts of interest to disclose.

© 2018 by the American Clinical Neurophysiology Society