2025/12/10 by Simma, Leopold, Moser, Katharina, Seiler, Michelle +3
#610 Medicine & #Altered mental status #Electroencephalogram #Emergency department #Nonconvulsive status epilepticus #Simplified EEG #Status epilepticus #health
paper · doi:10.5167/uzh-280765
Background: Nonconvulsive status epilepticus (NCSE) is a time-critical diagnosis in children presenting to pediatric emergency departments (PEDs). Diagnostic delays are common, particularly when isolated altered mental status (AMS) is the only symptom. A standard electroencephalogram (EEG) is essential for diagnosis but rarely available outside regular working hours. Point-of-care EEG (pocEEG) is a rapid, bedside alternative that may support earlier recognition and treatment of NCSE in such situations. Methods: This study describes the use of a rapid, low-cost, two-channel pocEEG device during a quality improvement project at our tertiary PED. We report descriptive data of all cases, and focused on children with AMS following convulsive seizures but without apparent ongoing seizure activity. Results: Of 5 children diagnosed with NCSE, 4 were identified in the PED by using pocEEG. All presented outside regular working hours and had received prehospital benzodiazepines, and 4 had underlying neurological conditions. Levetiracetam was the initial intravenous in-hospital treatment in all cases; 2 required additional phenobarbital. In one case, standard EEG 23 h after presentation revealed focal seizures; retrospective review of the initial pocEEG showed an ictal-interictal continuum. Conclusions: Although all cases followed convulsive seizures, pocEEG may also assist in detecting NCSE in children with unexplained AMS and no seizure history. In our PED, pocEEG provided a pragmatic alternative that enabled early diagnosis and treatment of NCSE when standard EEG was unavailable. PocEEG may be a valuable tool for timely seizure detection and clinical decision-making in pediatric emergency care.