£149,289.85 project grant over 36 months awarded to Dr Vasiliki Tsirka at the Royal London Hospital, Barts’ Health

Scientific title: The use of continuous electroencephalographic (EEG) monitoring for cases of refractory status epilepticus: does it affect the final patient outcome?

 “This study will help identify the most appropriate way to manage patients with status epilepticus, optimise the investigation methods and monitor response to treatment.”

 Background

Prolonged epileptic seizures, so called status epilepticus, are a medical emergency as they carry a high risk of brain damage and death. Patients in status epilepticus require rapid and effective management. When the seizures are not controlled with initial medication, patients are treated in the Intensive Care Unit (ICU). Sometimes it is not possible to tell if patients are having ongoing seizures or not, but an electroencephalogram can record subtle seizures that cannot be detected by clinical examination, which can then be treated.  Continuous electroencephalographic (cEEG) monitoring, although widely recommended for cases of refractory status epilepticus, is not a routine practice in UK. The use of cEEG is limited by resource implications, and there is also uncertainty about the patient benefit. Specifically, it is not clear if cEEG affects the final outcome e.g. survival, side effects, other injuries, and quality of life.

The Study

This study aims to investigate if cEEG improves short and long term patient outcomes in cases of refractory status epilepticus (RSE). The researchers plan to assess the yield of cEEG as a diagnostic tool in ICU for patients with RSE, compared with the current standard practice and explore if the use of this monitoring can significantly change length of patient stay, time required to achieve seizure control, mortality, and quality of life up to 12 months after discharge. This project will determine the feasibility of a larger study.

cEEG is expensive, mainly due to the specialist manpower required, and this is one of the main factors for not implementing this service. The researchers plan to determine the cost-effectiveness for a cEEG service in ICU, comparing the cost with standard medical care, whilst taking into account the possible reduced length of stay and clinical interventions.

Significance

This project will add knowledge to the best management of patients with long seizures admitted in ICU, focusing on the use of cEEG monitoring. It may also inform us how best to use this technology to improve patient outcomes.