The diagnostic yield of a 2-h versus a 30-min electroencephalogram for patients with altered mental status in neurological intensive care unit

Nesma Mounir, Ehab Shaker Belal, Mahmoud Fathi Abozeina, Aliaa Ali Tawfeek
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Abstract

The continuous electroencephalogram (cEEG) monitoring is recommended for critical ill patients with altered mental status, The cEEG detects seizure activity and nonconvulsive status epilepticus (NCSE) more efficiently than routine electroencephalogram (rEEG). Yet, cEEG is not widely available in many neurological intensive care units (NICU) in limited resource countries. Ideal study duration, and whether cEEG is useful and cost-effective in terms of patient outcome compared to (rEEG), is still questions under research. The main objective in our study was the relative diagnostic yield of the 2 h, prolonged EEG recording, compared to the 30-min rEEG recording in the NICU. There was no significant diagnostic yield for the 2-h electroencephalogram (EEG) over the 30-min EEG for patient with altered mental status in the NICU. Being with altered mental state in an NICU carries a poor outcome, we found that death occurred in 68.9% of patients. Acute ischemic stroke is the most common cause of altered mental status in NICU by about 53.3% of patients. Less than half of the patients (42.2%) were receiving anti-seizure medications (ASM). As long as the cEEG is not available in the NICU, the 30-min EEG has a good diagnostic yield and it is almost equivalent to the prolonged 2-h EEG, and if the EEG is recommended for a longer duration, we recommend a long-term EEG more than 2 h.
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对神经重症监护室精神状态改变患者进行 2 小时与 30 分钟脑电图比较的诊断率
与常规脑电图(rEEG)相比,连续脑电图能更有效地检测癫痫发作活动和非惊厥性癫痫状态(NCSE)。然而,在资源有限的国家,许多神经重症监护病房(NICU)并没有普及 cEEG。理想的研究持续时间,以及 cEEG 与(rEEG)相比在患者预后方面是否有用和具有成本效益,这些问题仍在研究中。我们研究的主要目的是在新生儿重症监护室中,与 30 分钟的脑电图记录相比,2 小时的长时间脑电图记录的诊断率相对较高。对于新生儿重症监护室中精神状态改变的患者,2 小时脑电图记录与 30 分钟脑电图记录相比没有明显的诊断率。在新生儿重症监护室出现精神状态改变的患者预后很差,我们发现 68.9% 的患者死亡。急性缺血性中风是导致新生儿重症监护室精神状态改变的最常见原因,约占 53.3%。不到一半的患者(42.2%)正在接受抗癫痫药物治疗(ASM)。只要新生儿重症监护室没有 cEEG,30 分钟脑电图就有很好的诊断率,几乎等同于长时间 2 小时脑电图,如果建议脑电图持续时间更长,我们建议长期脑电图超过 2 小时。
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