Electroencephalographic Reporting for Refractory Status Epilepticus

the Pediatric Status Epilepticus Research Group (pSERG)

doi:10.1097/WNP.0000000000000595

Electroencephalographic Reporting for Refractory Status Epilepticus

the Pediatric Status Epilepticus Research Group (pSERG)

Pediatrics

Research output: Contribution to journal › Article › peer-review

2 Scopus citations

Abstract

Purpose: We aimed to determine whether clinical EEG reports obtained from children in the intensive care unit with refractory status epilepticus could provide data for comparative effectiveness research studies. Methods: We conducted a retrospective descriptive study to assess the documentation of key variables within clinical continuous EEG monitoring reports based on the American Clinical Neurophysiology Society’s standardized EEG terminology for children with refractory status epilepticus from 10 academic centers. Two pediatric electroencephalographers reviewed the EEG reports. We compared reports generated using free text or templates. Results: We reviewed 191 EEG reports. Agreement between the electroencephalographers regarding whether a variable was described in the report ranged from fair to very good. The presence of electrographic seizures (ES) was documented in 46% (87/191) of reports, and these reports documented the time of first ES in 64% (56/87), ES duration in 72% (63/85), and ES frequency in 68% (59/ 87). Reactivity was documented in 16% (31/191) of reports, and it was more often documented in template than in free-text reports (40% vs. 14%, P ¼ 0.006). Other variables were not differentially reported in template versus free-text reports. Conclusions: Many key EEG features are not documented consistently in clinical continuous EEG monitoring reports, including ES characteristics and reactivity assessment. Standardization may be needed for clinical EEG reports to provide informative data for large multicenter observational studies.

Original language	English (US)
Pages (from-to)	365-370
Number of pages	6
Journal	Journal of Clinical Neurophysiology
Volume	36
Issue number	5
DOIs	https://doi.org/10.1097/WNP.0000000000000595
State	Published - Sep 1 2019

Funding

pSERG is funded by the Pediatric Epilepsy Research Foundation and the Epilepsy Research Fund. R. Arya receives research support from Procter Foundation (PI) and Maxon Foundation (Coinvestigator). I. Sánchez Fernández is funded by the Epilepsy Research Fund and was funded by Fundación Alfonso Martín Escudero and the HHV-6 Foundation. W. D. Gaillard derives income from clinical revenue generated for CNMC clinical care. He received federal support from NINDS, NICHD, NSF, and PICORI. He received foundation support from the American Heart Association, PERF. Epilepsy Research Editorial Board. Dmitry Tchapyjnikov has received consultation fees from IQVIA and Guidepoint. M. Gaínza-Lein was supported by the Epilepsy Research Fund and by a Boston Children’s Hospital investigator-initiated study from Upsher-Smith Laboratories. H. P. Goodkin was a member of the clinical standardization team for Sage Therapeutics. T. A. Glauser is funded by NIH grants 2U01-NS045911, U10-NS077311, R01-NS065840, and R01-HD073115. He has received consulting fees from Supernus. He had served as an expert consultant for the US Department of Justice and has received compensation for work as an expert on medico-legal cases. He receives royalties from a patent license from AssureX Health. A. Topjian is funded by NIH grant K23 k23NS075363, SAGE (site PI), and Laerdal. M. Wainwright serves on the Clinical Advisory Board of Sage Therapeutics, sponsor of a clinical trial for treatment of super-refractory status epilepticus; and is a coprincipal investigator on a Phase III study for the treatment of super-refractory status epilepticus sponsored by Sage Therapeutics. A. Wilfong reports research grant funding for epilepsy from GW Pharm, Novartis, Acorda, Upsher-Smith, Lundbeck, Zogenix, and Eisai; and reports receiving royalties from the publication of Up To Date chapters on epilepsy. T. Loddenkemper serves on the Council (and as the President) of the American Clinical Neurophysiology Society (active), serves on the American Board of Clinical Neurophysiology (active), served as an Associate Editor for Seizure, served on the Laboratory Accreditation Board for Long Term (Epilepsy and Intensive Care Unit) Monitoring, and serves as an Associate Editor for Wyllie’s Treatment of Epilepsy 6th and 7th edition. He is part of patent applications and license agreements to detect and predict clinical outcomes, and to manage, diagnose, and treat neurologic conditions, epilepsy and seizures, and future revenue from these scientific contributions cannot be ruled out. Dr. Loddenkemper is a coinventor of the TriVox Health technology. T. Loddenkemper, and Boston Children’s Hospital, may receive financial benefits in the form of license payments in the future. He received research support from the NIH, the Epilepsy Research Fund, the Epilepsy Foundation of America, the Epilepsy Therapy Project, the Pediatric Epilepsy Research Foundation, Lundbeck, Eisai, Upsher-Smith, Sunovion, Mallinckrodt, Empatica, Sage, and Pfizer, including past device donations from various companies, including SmartWatch, Empatica, and Neuroelectrics. He served as a consultant for Zogenix, Upsher-Smith, Amzell, Sunovion, Engage, Elsevier, UCB, Advance Medical, and Grand Rounds. He performs video electroencephalogram long-term and ICU monitoring, electroencephalograms, and other electrophysiological studies at Boston Children’s Hospital and affiliated hospitals and bills for these procedures, and he evaluates pediatric neurology patients and bills for clinical care. He has received speaker honorariums from national societies including the AAN, AES, and ACNS, and for Grand Rounds at various academic centers. His wife, Dr. Karen Stannard, is a pediatric neurologist and she performs video electroencephalogram long-term and ICU monitoring, electroencephalograms, and other electrophysiological studies and bills for these procedures, and she evaluates pediatric neurology patients and bills for clinical care. N. S. Abend serves as a consultant to Sage and receives research support from NIH (PI), PCCORI (Site PI), and PERF (site PI). The remaining authors have no funding or conflicts of interest to disclose.

Keywords

All clinical neurology
Critical care
EEG
Epilepsy
Status epilepticus

ASJC Scopus subject areas

Physiology
Neurology
Clinical Neurology
Physiology (medical)

Access to Document

10.1097/WNP.0000000000000595

Cite this

@article{aefbacb5c1f44537b4b81f8f94ef8c11,

title = "Electroencephalographic Reporting for Refractory Status Epilepticus",

abstract = "Purpose: We aimed to determine whether clinical EEG reports obtained from children in the intensive care unit with refractory status epilepticus could provide data for comparative effectiveness research studies. Methods: We conducted a retrospective descriptive study to assess the documentation of key variables within clinical continuous EEG monitoring reports based on the American Clinical Neurophysiology Society{\textquoteright}s standardized EEG terminology for children with refractory status epilepticus from 10 academic centers. Two pediatric electroencephalographers reviewed the EEG reports. We compared reports generated using free text or templates. Results: We reviewed 191 EEG reports. Agreement between the electroencephalographers regarding whether a variable was described in the report ranged from fair to very good. The presence of electrographic seizures (ES) was documented in 46% (87/191) of reports, and these reports documented the time of first ES in 64% (56/87), ES duration in 72% (63/85), and ES frequency in 68% (59/ 87). Reactivity was documented in 16% (31/191) of reports, and it was more often documented in template than in free-text reports (40% vs. 14%, P ¼ 0.006). Other variables were not differentially reported in template versus free-text reports. Conclusions: Many key EEG features are not documented consistently in clinical continuous EEG monitoring reports, including ES characteristics and reactivity assessment. Standardization may be needed for clinical EEG reports to provide informative data for large multicenter observational studies.",

keywords = "All clinical neurology, Critical care, EEG, Epilepsy, Status epilepticus",

author = "{the Pediatric Status Epilepticus Research Group (pSERG)} and Sansevere, {Arnold J.} and Ravindra Arya and Fern{\'a}ndez, {Iv{\'a}n S{\'a}nchez} and Gaillard, {William D.} and Tasker, {Robert C.} and Lai, {Yi Chen} and Anderson, {Anne E.} and Dmitry Tchapyjnikov and Chapman, {Kevin E.} and Brenton, {J. Nicholas} and Carpenter, {Jessica L.} and Marina Ga{\'i}nza-Lein and Goldstein, {Joshua L.} and Goodkin, {Howard P.} and Jackson, {Michele C.} and Kush Kapur and Mikati, {Mohamad A.} and Katrina Peariso and Glauser, {Tracy A.} and Topjian, {Alexis A.} and Mark Wainwright and Wilfong, {Angus A.} and Williams, {Korwyn L.} and Tobias Loddenkemper and Abend, {Nicholas S.}",

note = "Funding Information: pSERG is funded by the Pediatric Epilepsy Research Foundation and the Epilepsy Research Fund. R. Arya receives research support from Procter Foundation (PI) and Maxon Foundation (Coinvestigator). I. S{\'a}nchez Fern{\'a}ndez is funded by the Epilepsy Research Fund and was funded by Fundaci{\'o}n Alfonso Mart{\'i}n Escudero and the HHV-6 Foundation. W. D. Gaillard derives income from clinical revenue generated for CNMC clinical care. He received federal support from NINDS, NICHD, NSF, and PICORI. He received foundation support from the American Heart Association, PERF. Epilepsy Research Editorial Board. Dmitry Tchapyjnikov has received consultation fees from IQVIA and Guidepoint. M. Ga{\'i}nza-Lein was supported by the Epilepsy Research Fund and by a Boston Children{\textquoteright}s Hospital investigator-initiated study from Upsher-Smith Laboratories. H. P. Goodkin was a member of the clinical standardization team for Sage Therapeutics. T. A. Glauser is funded by NIH grants 2U01-NS045911, U10-NS077311, R01-NS065840, and R01-HD073115. He has received consulting fees from Supernus. He had served as an expert consultant for the US Department of Justice and has received compensation for work as an expert on medico-legal cases. He receives royalties from a patent license from AssureX Health. A. Topjian is funded by NIH grant K23 k23NS075363, SAGE (site PI), and Laerdal. M. Wainwright serves on the Clinical Advisory Board of Sage Therapeutics, sponsor of a clinical trial for treatment of super-refractory status epilepticus; and is a coprincipal investigator on a Phase III study for the treatment of super-refractory status epilepticus sponsored by Sage Therapeutics. A. Wilfong reports research grant funding for epilepsy from GW Pharm, Novartis, Acorda, Upsher-Smith, Lundbeck, Zogenix, and Eisai; and reports receiving royalties from the publication of Up To Date chapters on epilepsy. T. Loddenkemper serves on the Council (and as the President) of the American Clinical Neurophysiology Society (active), serves on the American Board of Clinical Neurophysiology (active), served as an Associate Editor for Seizure, served on the Laboratory Accreditation Board for Long Term (Epilepsy and Intensive Care Unit) Monitoring, and serves as an Associate Editor for Wyllie{\textquoteright}s Treatment of Epilepsy 6th and 7th edition. He is part of patent applications and license agreements to detect and predict clinical outcomes, and to manage, diagnose, and treat neurologic conditions, epilepsy and seizures, and future revenue from these scientific contributions cannot be ruled out. Dr. Loddenkemper is a coinventor of the TriVox Health technology. T. Loddenkemper, and Boston Children{\textquoteright}s Hospital, may receive financial benefits in the form of license payments in the future. He received research support from the NIH, the Epilepsy Research Fund, the Epilepsy Foundation of America, the Epilepsy Therapy Project, the Pediatric Epilepsy Research Foundation, Lundbeck, Eisai, Upsher-Smith, Sunovion, Mallinckrodt, Empatica, Sage, and Pfizer, including past device donations from various companies, including SmartWatch, Empatica, and Neuroelectrics. He served as a consultant for Zogenix, Upsher-Smith, Amzell, Sunovion, Engage, Elsevier, UCB, Advance Medical, and Grand Rounds. He performs video electroencephalogram long-term and ICU monitoring, electroencephalograms, and other electrophysiological studies at Boston Children{\textquoteright}s Hospital and affiliated hospitals and bills for these procedures, and he evaluates pediatric neurology patients and bills for clinical care. He has received speaker honorariums from national societies including the AAN, AES, and ACNS, and for Grand Rounds at various academic centers. His wife, Dr. Karen Stannard, is a pediatric neurologist and she performs video electroencephalogram long-term and ICU monitoring, electroencephalograms, and other electrophysiological studies and bills for these procedures, and she evaluates pediatric neurology patients and bills for clinical care. N. S. Abend serves as a consultant to Sage and receives research support from NIH (PI), PCCORI (Site PI), and PERF (site PI). The remaining authors have no funding or conflicts of interest to disclose. Publisher Copyright: Copyright {\textcopyright} 2019 by the American Clinical Neurophysiology Society",

year = "2019",

month = sep,

day = "1",

doi = "10.1097/WNP.0000000000000595",

language = "English (US)",

volume = "36",

pages = "365--370",

journal = "Journal of Clinical Neurophysiology",

issn = "0736-0258",

publisher = "Lippincott Williams and Wilkins Ltd.",

number = "5",

}

TY - JOUR

T1 - Electroencephalographic Reporting for Refractory Status Epilepticus

AU - the Pediatric Status Epilepticus Research Group (pSERG)

AU - Sansevere, Arnold J.

AU - Arya, Ravindra

AU - Fernández, Iván Sánchez

AU - Gaillard, William D.

AU - Tasker, Robert C.

AU - Lai, Yi Chen

AU - Anderson, Anne E.

AU - Tchapyjnikov, Dmitry

AU - Chapman, Kevin E.

AU - Brenton, J. Nicholas

AU - Carpenter, Jessica L.

AU - Gaínza-Lein, Marina

AU - Goldstein, Joshua L.

AU - Goodkin, Howard P.

AU - Jackson, Michele C.

AU - Kapur, Kush

AU - Mikati, Mohamad A.

AU - Peariso, Katrina

AU - Glauser, Tracy A.

AU - Topjian, Alexis A.

AU - Wainwright, Mark

AU - Wilfong, Angus A.

AU - Williams, Korwyn L.

AU - Loddenkemper, Tobias

AU - Abend, Nicholas S.

N1 - Funding Information: pSERG is funded by the Pediatric Epilepsy Research Foundation and the Epilepsy Research Fund. R. Arya receives research support from Procter Foundation (PI) and Maxon Foundation (Coinvestigator). I. Sánchez Fernández is funded by the Epilepsy Research Fund and was funded by Fundación Alfonso Martín Escudero and the HHV-6 Foundation. W. D. Gaillard derives income from clinical revenue generated for CNMC clinical care. He received federal support from NINDS, NICHD, NSF, and PICORI. He received foundation support from the American Heart Association, PERF. Epilepsy Research Editorial Board. Dmitry Tchapyjnikov has received consultation fees from IQVIA and Guidepoint. M. Gaínza-Lein was supported by the Epilepsy Research Fund and by a Boston Children’s Hospital investigator-initiated study from Upsher-Smith Laboratories. H. P. Goodkin was a member of the clinical standardization team for Sage Therapeutics. T. A. Glauser is funded by NIH grants 2U01-NS045911, U10-NS077311, R01-NS065840, and R01-HD073115. He has received consulting fees from Supernus. He had served as an expert consultant for the US Department of Justice and has received compensation for work as an expert on medico-legal cases. He receives royalties from a patent license from AssureX Health. A. Topjian is funded by NIH grant K23 k23NS075363, SAGE (site PI), and Laerdal. M. Wainwright serves on the Clinical Advisory Board of Sage Therapeutics, sponsor of a clinical trial for treatment of super-refractory status epilepticus; and is a coprincipal investigator on a Phase III study for the treatment of super-refractory status epilepticus sponsored by Sage Therapeutics. A. Wilfong reports research grant funding for epilepsy from GW Pharm, Novartis, Acorda, Upsher-Smith, Lundbeck, Zogenix, and Eisai; and reports receiving royalties from the publication of Up To Date chapters on epilepsy. T. Loddenkemper serves on the Council (and as the President) of the American Clinical Neurophysiology Society (active), serves on the American Board of Clinical Neurophysiology (active), served as an Associate Editor for Seizure, served on the Laboratory Accreditation Board for Long Term (Epilepsy and Intensive Care Unit) Monitoring, and serves as an Associate Editor for Wyllie’s Treatment of Epilepsy 6th and 7th edition. He is part of patent applications and license agreements to detect and predict clinical outcomes, and to manage, diagnose, and treat neurologic conditions, epilepsy and seizures, and future revenue from these scientific contributions cannot be ruled out. Dr. Loddenkemper is a coinventor of the TriVox Health technology. T. Loddenkemper, and Boston Children’s Hospital, may receive financial benefits in the form of license payments in the future. He received research support from the NIH, the Epilepsy Research Fund, the Epilepsy Foundation of America, the Epilepsy Therapy Project, the Pediatric Epilepsy Research Foundation, Lundbeck, Eisai, Upsher-Smith, Sunovion, Mallinckrodt, Empatica, Sage, and Pfizer, including past device donations from various companies, including SmartWatch, Empatica, and Neuroelectrics. He served as a consultant for Zogenix, Upsher-Smith, Amzell, Sunovion, Engage, Elsevier, UCB, Advance Medical, and Grand Rounds. He performs video electroencephalogram long-term and ICU monitoring, electroencephalograms, and other electrophysiological studies at Boston Children’s Hospital and affiliated hospitals and bills for these procedures, and he evaluates pediatric neurology patients and bills for clinical care. He has received speaker honorariums from national societies including the AAN, AES, and ACNS, and for Grand Rounds at various academic centers. His wife, Dr. Karen Stannard, is a pediatric neurologist and she performs video electroencephalogram long-term and ICU monitoring, electroencephalograms, and other electrophysiological studies and bills for these procedures, and she evaluates pediatric neurology patients and bills for clinical care. N. S. Abend serves as a consultant to Sage and receives research support from NIH (PI), PCCORI (Site PI), and PERF (site PI). The remaining authors have no funding or conflicts of interest to disclose. Publisher Copyright: Copyright © 2019 by the American Clinical Neurophysiology Society

PY - 2019/9/1

Y1 - 2019/9/1

N2 - Purpose: We aimed to determine whether clinical EEG reports obtained from children in the intensive care unit with refractory status epilepticus could provide data for comparative effectiveness research studies. Methods: We conducted a retrospective descriptive study to assess the documentation of key variables within clinical continuous EEG monitoring reports based on the American Clinical Neurophysiology Society’s standardized EEG terminology for children with refractory status epilepticus from 10 academic centers. Two pediatric electroencephalographers reviewed the EEG reports. We compared reports generated using free text or templates. Results: We reviewed 191 EEG reports. Agreement between the electroencephalographers regarding whether a variable was described in the report ranged from fair to very good. The presence of electrographic seizures (ES) was documented in 46% (87/191) of reports, and these reports documented the time of first ES in 64% (56/87), ES duration in 72% (63/85), and ES frequency in 68% (59/ 87). Reactivity was documented in 16% (31/191) of reports, and it was more often documented in template than in free-text reports (40% vs. 14%, P ¼ 0.006). Other variables were not differentially reported in template versus free-text reports. Conclusions: Many key EEG features are not documented consistently in clinical continuous EEG monitoring reports, including ES characteristics and reactivity assessment. Standardization may be needed for clinical EEG reports to provide informative data for large multicenter observational studies.

AB - Purpose: We aimed to determine whether clinical EEG reports obtained from children in the intensive care unit with refractory status epilepticus could provide data for comparative effectiveness research studies. Methods: We conducted a retrospective descriptive study to assess the documentation of key variables within clinical continuous EEG monitoring reports based on the American Clinical Neurophysiology Society’s standardized EEG terminology for children with refractory status epilepticus from 10 academic centers. Two pediatric electroencephalographers reviewed the EEG reports. We compared reports generated using free text or templates. Results: We reviewed 191 EEG reports. Agreement between the electroencephalographers regarding whether a variable was described in the report ranged from fair to very good. The presence of electrographic seizures (ES) was documented in 46% (87/191) of reports, and these reports documented the time of first ES in 64% (56/87), ES duration in 72% (63/85), and ES frequency in 68% (59/ 87). Reactivity was documented in 16% (31/191) of reports, and it was more often documented in template than in free-text reports (40% vs. 14%, P ¼ 0.006). Other variables were not differentially reported in template versus free-text reports. Conclusions: Many key EEG features are not documented consistently in clinical continuous EEG monitoring reports, including ES characteristics and reactivity assessment. Standardization may be needed for clinical EEG reports to provide informative data for large multicenter observational studies.

KW - All clinical neurology

KW - Critical care

KW - EEG

KW - Epilepsy

KW - Status epilepticus

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U2 - 10.1097/WNP.0000000000000595

DO - 10.1097/WNP.0000000000000595

M3 - Article

C2 - 31166226

AN - SCOPUS:85071783521

SN - 0736-0258

VL - 36

SP - 365

EP - 370

JO - Journal of Clinical Neurophysiology

JF - Journal of Clinical Neurophysiology

IS - 5

ER -

Electroencephalographic Reporting for Refractory Status Epilepticus

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