What is the approach to implementing ambulatory Electroencephalography (EEG)?

From the Guidelines

Ambulatory Electroencephalography (EEG) should be implemented with a structured approach, prioritizing patient selection, comprehensive pre-test consultation, and proper equipment setup to capture nonconvulsive seizure activity or titrate electrosuppressive medication, as recommended for adult ICU patients 1. The approach to implementing ambulatory EEG involves several key steps, including:

• Proper patient selection, focusing on individuals with suspected seizures or episodic behavioral changes that haven't been captured during standard EEG recordings
• A comprehensive pre-test consultation to review the patient's clinical history and set expectations
• Equipment setup, involving placement of electrodes according to the international 10-20 system, securing them with collodion adhesive, and connecting them to a portable recording device
• Patient education on maintaining electrode integrity, operating the event marker button, and handling the equipment
• A detailed event diary to document symptoms, activities, and sleep-wake cycles during the recording period The use of ambulatory EEG is supported by guidelines for monitoring nonconvulsive seizure activity in adult ICU patients with either known or suspected seizures, or to titrate electrosuppressive medication to achieve burst suppression in adult ICU patients with elevated intracranial pressure, as stated in the clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit 1. Key considerations for ambulatory EEG implementation include:
• The duration of the recording period, which can range from 24-72 hours depending on the clinical question
• The importance of clear instructions and technical support for patients to ensure accurate data collection
• The need for interpretation by a neurologist with expertise in EEG analysis to accurately diagnose and characterize seizure types, evaluate treatment efficacy, and distinguish between epileptic and non-epileptic events.

From the Research

Approach to Implementing Ambulatory Electroencephalography (EEG)

The approach to implementing ambulatory EEG involves several key considerations, including:

• Determining the optimal duration of recording to capture clinical events, with studies suggesting at least 48 hours for children and at least 72 hours for adult and geriatric samples 2
• Utilizing a system of electrodes, recording apparatus, and software to record cerebral electrical activity or other biological signals during long periods, typically not less than 24 hours 3
• Selecting patients carefully to ensure a high diagnostic yield, with ambulatory EEG being particularly useful for characterizing patients with non-epileptic events, clarifying diagnoses of epilepsy, and quantifying spikes and seizures to improve medical management 4
• Considering the use of ambulatory EEG as a cost-effective alternative to inpatient video-EEG monitoring, with a high diagnostic yield of 72% reported in one study 4

Key Considerations

Some key considerations when implementing ambulatory EEG include:

• The duration of recording, with longer durations capturing a wider majority of both first typical events and subsequent events 2, 5
• The type of patients being monitored, with ambulatory EEG being useful for patients with epilepsy, hypersomnia, or disorders of the wakefulness-sleep cycle 3
• The equipment and software used, with advancements in technology allowing for greater scalp coverage and better localization of attacks and EEG abnormalities 6
• The analysis of the recorded data, with automated analysis techniques available for certain types of data, such as spike and wave activity and sleep stages 6