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Continuous EEG Monitoring Predicts a Clinically Meaningful Recovery Among Adult Inpatients

Selioutski, Olga*; Roberts, Debra; Hamilton, Ross; Ghosh, Hia§; Nickels, Jean; Konig Toro, Francesca; Kruppenbacher, Matthew#; Auinger, Peggy**; Kaplan, Peter W.††; Birbeck, Gretchen L.*

Journal of Clinical Neurophysiology: September 2019 - Volume 36 - Issue 5 - p 358–364
doi: 10.1097/WNP.0000000000000594
Original Research
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Purpose: Continuous EEG (cEEG) monitoring is primarily used for diagnosing seizures and status epilepticus, and for prognostication after cardiorespiratory arrest. The purpose of this study was to investigate whether cEEG could predict survival and meaningful recovery.

Methods: The authors reviewed inpatient cEEG reports obtained between January 2013 and November 2015 and recorded demographics, preadmission modified Rankin Scale, history of preexisting epilepsy, Glasgow Coma Scale for those admitted to the intensive care unit, and EEG data (posterior dominant rhythm, reactivity, epileptiform discharges, seizures, and status epilepticus). Associations between clinical outcomes (death vs. survival or clinically meaningful recovery [inpatient rehabilitation, home-based rehabilitation, or home] vs. other [death, skilled nursing facility]) and cEEG findings were assessed with logistic regression models. P < 0.05 was considered significant.

Results: For 218 cEEG reports (197 intensive care unit admits), the presence of at least a unilateral posterior dominant rhythm was associated with survival (odds ratio for death, 0.38; 95% confidence interval, 0.19–0.77; P = 0.01) and with a clinically meaningful outcome (odds ratio, 3.26; 95% confidence interval, 1.79–5.93; P < 0.001); posterior dominant rhythm remained significant after adjusting for preadmission disability. Those with preexisting epilepsy had better odds of a meaningful recovery (odds ratio, 3.31; 95% CI, 1.34–8.17; P = 0.001). Treated seizures and status epilepticus were not associated with a worse mortality (P = 0.6) or disposition (P = 0.6). High Glasgow Coma Scale (≥12) at intensive care unit admission was associated with a clinically meaningful recovery (odds ratio, 16.40; 95% confidence interval, 1.58–170.19; P = 0.02).

Conclusions: Continuous EEG findings can be used to prognosticate survival and functional recovery, and provide guidance in establishing goals of care.

*Epilepsy Division, Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, New York, U.S.A.;

Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, New York, U.S.A.;

R. Hamilton Naval Hospital Camp Pendleton, Oceanside, California, U.S.A.;

§University of Rochester, Rochester, New York, U.S.A.;

Department of Physical Medicine and Rehabilitation, University of Rochester, Rochester, New York, U.S.A.;

Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, U.S.A.;

#Rochester Regional Health Spine Center, Rochester, New York, U.S.A.;

**Department of Neurology, Center for Health and Technology, University of Rochester School of Medicine and Dentistry, Rochester, New York, U.S.A.; and

††Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.

Address correspondence and reprint requests to Olga Selioutski, DO, Department of Neurology, UR Epilepsy Center, University of Rochester Medical Center, School of Medicine and Dentistry, 601 Elmwood Avenue, PO Box 673, Rochester, NY 14642, U.S.A.; e-mail: olga_selioutski@urmc.rochester.edu.

O. Selioutski has received support from SAGE Therapeutics, Sepracor/Sunovion, USL261 for being a primary investigator in industry-sponsored clinical trials. D. Roberts serves on the scientific advisory board of Cryothermic Systems. P. W. Kaplan has served on the board of the ACNS and the ABCN, received honoraria from Demos and Wiley-Blackwell for books on EEG and epilepsy; consultant to Lundbeck and Cadwell; been an expert witness on epilepsy and qEEG. G. L. Birbeck has received support from the US NIH for studies of epilepsy, seizures, malaria and HIV and from GlaxoSmithKline for consultation related to the antimalarial medication, Tafenoquine. She serves on the Board of Directors for the American Neurological Association and on the Advisory Board for the US National Institute of Health's Fogarty International Center. None of these activities are related to the work presented here. The remaining authors have no funding or conflicts of interest to disclose.

Presented in part at the GCS Predicts Survival and Discharge Disposition in Patients with Acute Cerebral Injury. AAN Conference, April 25, 2018.

© 2019 by the American Clinical Neurophysiology Society