Current practice in administration and clinical criteria of emergent EEG

Policies of administration and availability of EEG offered during nonbusine ss hours vary widely among EEG laboratories. The authors surveyed medical d irectors of accredited EEG laboratories (n = 84) to determine the ranges of availability and clinical indications for approval of continuously availab le emergent EEG (E-EEG). Of 46 respondents. 37 (80%) offered E-EEG. Two cen ters recently lost funding for E-EEG. Availability was not associated with the total number of EEGs performed annually. The mean estimated response ti me from request to expert interpretation was 3 +/- 4 hours (range, 1-24 hou rs). The five clinical indications for which most respondents approved E-EE Gs were possible nonconvulsive status epilepticus (100%), treatment of stat us epilepticus (84%). cerebral death exam (81%), diagnosis of convulsive st atus epilepticus (79%), and diagnosis of coma or encephalopathy (70%). Resp ondents disagreed widely when asked which clinical situations merited E-EEG . with some approving all requests and others denying all except for noncon vulsive status epilepticus. The wide range of current practice suggests tha t research focused on outcomes of aggressive, EEG-aided patient evaluation and treatment are needed to define better the costs and benefits of a conti nuously available EEG service.