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Time Is Brain

The Use of EEG Electrode Caps to Rapidly Diagnose Nonconvulsive Status Epilepticus

McKay, Jake H.*; Feyissa, Anteneh M.*; Sener, Ugur; D'Souza, Caitlin*; Smelick, Chris*; Spaulding, Aaron; Yelvington, Kirsten§; Tatum, William O.*

Journal of Clinical Neurophysiology: November 2019 - Volume 36 - Issue 6 - p 460–466
doi: 10.1097/WNP.0000000000000603
Original Research

Objective: To perform a feasibility pilot study comparing the usefulness of EEG electrode cap versus standard scalp EEG for acquiring emergent EEGs in emergency department, inpatient, and intensive care unit patients.

Background: Nonconvulsive status epilepticus (NCSE) is a neurological emergency diagnosed exclusively by EEG. Nonconvulsive status epilepticus becomes more resistant to treatment 1 hour after continued seizure activity. EEG technologists are alerted “stat” when there is immediate need for an EEG during oncall hours, yet delays are inevitable. Alternatively, EEG caps can be quickly placed by in-house residents at bedside for assessment.

Design/Methods: EEG caps were compared with standard-of-care “stat” EEGs for 20 patients with suspected NCSE. After the order for a stat EEG was placed, neurology residents were simultaneously alerted and placed an EEG cap prior to the arrival of the on-call out-of-hospital technologist. Both EEG cap recordings and standard EEG recordings were visually reviewed at 10 and 20 minutes in a blinded manner by two electroencephalographers. The timing, accuracy of interpretation, and diagnosis between the two techniques were then compared.

Results: Of the 20 adult patients, 70% (14 of 20) of EEG cap recordings were interpretable, whereas 95% (19 of 20) standard EEGs were interpretable; three had findings consistent with NCSE on both the EEG cap and standard EEG recordings. In the time analysis, 16 patients were included. EEG cap placement was significantly more time efficient than an EEG performed by technologist using the usual “statEEG protocol, with the median EEG cap electrode placement occurring 86 minutes faster than standard EEG (22.5 minutes vs. 104.5 minutes; P < 0.0001; n = 16).

Conclusions: New rapid EEG recording using improved EEG caps may allow for rapid diagnosis and clinical decision making in suspected NCSE.

*Department of Neurology, Mayo Clinic, Jacksonville, Florida, U.S.A.;

Department of Neurology, Memorial Sloan-Kettering Hospital, New York, New York, U.S.A.;

Mayo Clinic, Jacksonville, Florida, U.S.A.; and

§Department of Clinical Neurophysiology, Mayo Clinic, Jacksonville, Florida, U.S.A.

Address correspondence and reprint requests to William O. Tatum, DO, FACNS, Department of Neurology, Mayo Clinic Cannaday, 2 East 4500 San Pablo Rd, Jacksonville, Florida 32224, U.S.A.; e-mail:

The authors have no funding or conflicts of interest to disclose.

Presented at American Academy of Neurology Annual Meeting, Los Angeles, CA, 2018 and at American Clinical Neurophysiology Society, Washington, DC, 2018.

© 2019 by the American Clinical Neurophysiology Society