Abstract Details

Title Lack of Standardization of the Level of Encephalopathy on EEG: a Barrier to the Widespread Use of EEG for Brain Monitoring

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 6-001

Objective Lack of consensus on standardized approaches to electroencephalogram (EEG) background analysis and reporting of the overall degree of encephalopathy limits the use of continuous monitoring in the assessment of severity of brain dysfunction. Thus, we sought to demonstrate practice variability in reporting encephalopathy grades of EEG.

Background The widespread use of EEG beyond seizure detection has unveiled its additional utility as a continuous monitoring method for the detection of focal and diffuse brain dysfunction, and in neuroprognostication. However, no consensus exists to guide electroencephalographers in determining the degree of brain dysfunction.

Design/Methods A web-based survey (Qualtrics®) was disseminated to Critical Care EEG Monitoring Research Consortium (CCERMC) participants by the American Clinical Neurophysiology Society (ACNS) in 2017. Following consent, respondents answered 12 background questions about their training and practice, and then graded 40 EEG segments (15-second epoch depicting patients’ most stimulated state) for their degree of cerebral dysfunction. Fleiss Kappa was used for inter-rater agreement (IRA) assessment.

Results 110 responses were obtained; approximately half of respondents had passed the CCERMC nomenclature certification test (52.1%, n=49). The majority of respondents were attendings (78.2%, n=86), and nearly 83% agreed that a standardized approach to grading EEG level of brain dysfunction is needed. The overall IRA of EEG epoch was fair (k=0.32), regardless of level of training (attendings k=0.30, fellows k=0.32). No EEG epoch achieved perfect agreement despite depicting extremes (from normal to severe brain dysfunction). Having CCEMRC nomenclature certification did not improve IRA (k=0.26).

Conclusions We demonstrated the current lack of uniformity and the widespread desire for an encephalopathy grading scale to aid consensus EEG interpretation. The ACNS standardized critical care EEG terminology has facilitated the understanding of rhythmic and periodic patterns. Broadening the terminology in future revisions to include an encephalopathy grading scale may be useful in reducing variability in reporting levels of cerebral dysfunction.

Authors/Disclosures
Carolina B. Maciel, MD, MSCR, FAAN PRESENTER	Dr. Maciel has received research support from American Heart Association. Dr. Maciel has received research support from National Institute of Health.
Eliezer Sternberg, MD (Milford Regional Neurology)	No disclosure on file
	No disclosure on file
	No disclosure on file
Nishi Rampal, MD (Yale University)	Dr. Rampal has received personal compensation for serving as an employee of Amgen. Dr. Rampal has received personal compensation for serving as an employee of Horizon Therapeutics. Dr. Rampal has stock in Amgen. Dr. Rampal has stock in Horizon Therapeutics.
Lawrence J. Hirsch, MD, FAAN (Yale University Comprehensive Epilepsy Center)	Dr. Hirsch has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Ceribell. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for marinus. The institution of Dr. Hirsch has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Natus. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neurelis. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eisai. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Rapport Therapeutics. Dr. Hirsch has received publishing royalties from a publication relating to health care. Dr. Hirsch has received publishing royalties from a publication relating to health care. Dr. Hirsch has received personal compensation in the range of $5,000-$9,999 for serving as a Speaker; Faculty for Fellows' training course with Neuropace. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Speaker with Natus.
Emily J. Gilmore, MD (Yale University School of Medicine)	Dr. Gilmore has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for carpl.ai. Dr. Gilmore has received personal compensation in the range of $0-$499 for serving as a Consultant for AAN. Dr. Gilmore has received research support from NIH.

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