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All Seizures Are Not Shaking and All Shakings Are Not a Seizure

By Currents Editor posted 09-18-2018 14:22

audrey.jpgBy Audrey Paulson, DNP

Electroencephalograms (EEGs) are usually placed on the patient by the EEG tech, and the process takes at least 30 minutes. It is then read by the neurologist, occasionally in real time but often after the fact. This results in the diagnosis of a seizure long after the seizure is over. Nursing typically does not play a huge role in this process except to alert the physician if they see any type of seizure activity. One FDA-approved product available on the market is Ceribell™. It is a device that can change how nursing functions in the care of the patient with seizures.

Most members of NCS are aware that epilepsy is the fourth most common neurological disease, with 150,000 new cases diagnosed in the United States every year. In fact, there are 65 million people worldwide and 3.4 million people in the United States that live with this disease. This results in one out of 26 people having epilepsy, and, of these individuals, six out of 10 have no known cause. In order to be considered epileptic, one must have more than one unprovoked seizure. Despite there being a plethora of medications available for treating epilepsy, one-third of those with this condition still have uncontrolled seizures. That translates to 1 million people in the U.S. taking multiple medications with uncontrolled seizures.

The first step in treating any disease is having an accurate diagnosis. This is often a challenge with seizures, and both overand under-treatment occurs. The EEG was first performed in 1924 and is considered the gold standard for diagnosing seizures. When a patient arrives to the emergency room having a seizure, the primary initial goal is to stop it. Clinically, seizure cessation becomes less likely as time to therapy lengthens. This translates to treatment often done without obtaining an EEG due to the delay experienced in obtaining EEGs. The lack of STAT EEG availability results in treatment without diagnosis. One must remember that not all shaking is a seizure and not all seizures result in shaking.

In the neuro-ICU, many conditions commonly seen in our patients increase the likelihood of having NCSE. Therefore, this should be on the forefront of differentials for any neuro patient not responding as expected. In 2012, NCS published guidelines for SE, and those guidelines recommend obtaining the EEG within 15 to 60 minutes of onset of a seizure. They also recommend EEG if the patient is not waking up from GCSE to evaluate for NCSE. Complying with this EEG recommendation can be problematic due to lack of technicians, lack of equipment and delay in interpreting the results. In many hospitals, there is no means of obtaining an urgent or STAT EEG. Fortunately, technology is providing solutions.

Ceribell™ offers rapid EEG acquisition and does not require extensive training to use the device. Application is simple. Within less than five minutes, clinical quality EEG is available for viewing. The physician ordering the EEG can read the results in real time or one can choose the option of having the information sent securely to the cloud and read by another neurologist. This option is perfect for those facilities that may not have neurologists on-site.

Ceribell™ adds another feature that facilitates the emergent triaging of patients and allows even the untrained to diagnose accurately if the patient is having a seizure. It is well understood that seizures occur because of increased, uncontrolled electrical activity in the brain. Ceribell™ converts electrical activity to sound, so when there is no seizure occurring, this device makes a humming sound, similar to white noise. When seizures occurs, the sound is distinctly rhythmic, louder and easy to identify. One can hear the seizure, which makes it possible for one with minimal training to place device and hear when the patient is experience NCSE. Ceribell™ does not replace the epileptoligist or neurologist, but it does provide an assistance in determining the urgency and necessity of the consultation and help determine whether treatment is necessary or not. This device fills a void long experienced in the EEG arena. Emergency room physician, neuro-ICU nurses or the rapid response nurse can use Ceribell™ as a screening device to answer the urgent question: Is my patient having a seizure?

#LeadingInsights #Nursing #AudreyPaulson #September2018​​
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