Rapid diagnosis of pediatric nonconvulsive status epilepticus using point-of-care EEG

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.