Use of Continuous EEG Monitoring in Children Presenting with Encephalopathy following Convulsive Status Epilepticus

Purpose:The Critical Care Continuous EEG Task Force of the American Clinical Neurophysiology Society recommends continuous EEG (cEEG) monitoring in patients with persistent encephalopathy following convulsive status epilepticus. This recommendation is based on data, which correlates prolonged nonconvulsive seizures and nonconvulsive status epilepticus with worse neurologic outcomes. Compliance with these recommendations may be limited by barriers such as inadequate resource and staff availability. We surveyed members of the Child Neurology Society to determine the barriers that prevent them from appropriately using cEEG, and how they have successfully overcome such obstacles.Methods:A survey was electronically distributed to Child Neurology Society members, which assessed demographics, current clinical practices, and cEEG utilization in critically ill children, with an emphasis on resource availability and strategies to overcome resource limitations.Results:One hundred forty-six physicians from Child Neurology Society completed the survey. Fifty-three (39.8%) respondents use cEEG to detect nonconvulsive seizures/nonconvulsive status epilepticus in most (>90%) of their pediatric patients who present with persistent encephalopathy following convulsive status epilepticus. Forty-four respondents (34.4%) perceive barriers to performing cEEG monitoring, and 107 (84.9%) of the respondents are implementing changes to overcome barriers. The two most commonly reported barriers included inadequate availability of technicians and EEG machines. The most common changes included hiring new EEG technologists and purchasing new machines. Other barriers included identification of appropriate patients and availability of remote EEG monitoring capabilities.Conclusions:Barriers, such as resource limitations, prevent compliance with the American Clinical Neurophysiology Society cEEG monitoring recommendations. Recognizing common limitations and learning from each other about successful strategies to overcome these barriers may improve care.