ACNS Recommends In-Home (Ambulatory) EEG Monitoring for Appropriate Patients
Patients with epilepsy and seizure-like disorders continue to need care and services during the COVID-19 pandemic. Access to these services in neurodiagnostic labs and epilepsy monitoring units has been disrupted in many places. As a result of these disruptions and concerns for patient exposure to COVID-19, the American Clinical Neurophysiology Society (ACNS) is recommending home-based EEG monitoring for appropriate patients.
NOTE: The situation surrounding COVID-19 is evolving rapidly and ACNS first recommends that clinicians follow policies and guidelines set by their institution and state and federal authorities. The following are considerations and approaches to be considered when developing policies and protocols.
Inpatient EEG
Inpatient EEG
Neurology or Neurophysiology attending should establish medical necessity and appropriate timing of all NDT studies on COVID +/PUI.
If NDT staffing is limited then consider Neurology or Neurophysiology approval of ALL NDT procedures, regardless of COVID status. Determine in advance who will be involved in the approval process (Neurology resident, Neurophysiology fellows, attending physicians).
Give careful consideration to whether EEGs ordered as routine should be converted to continuous (long-term) EEG prior to the start of the procedure to reduce the need for re-connections and time in the room.
Elective EEG monitoring/EMU
In keeping with national directives to limit elective admissions to optimize bed availability for potential COVID-19 patients, many institutions have cancelled elective EMU admissions. Local factors, including COVID-19 activity in the region and utilization of resources in the hospital may impact this decision.
Consider the urgency of the request and alternatives to elective EEG monitoring (particularly for diagnostic evaluations).
- Acquire home video of events.
- Consider in-home (ambulatory) EEG or video EEG monitoring.
Outpatient EEG
Ambulatory EEG (with video if available)
Balance risk vs. benefit; Ambulatory EEG data may inform treatment to avoid ED visits.
Cleaning – Clean all surfaces with antiseptic wipes.
If not already being done, consider having hookup and take down done at the outpatient lab (or even that patient’s home) and not the hospital to limit exposure and hospital traffic.
Outpatient “Routine” Neurodiagnostic Procedures
Due to the potential risk of infectious exposure to both patients and healthcare providers, hospitals are encouraged to postpone non-urgent elective outpatient procedures such as EEG and EMG.
However, urgency of a particular procedure should always be considered on an individual basis.
Stratus is committed to supporting you and your patients during this pandemic.
We continue to provide in-home video EEG monitoring services and adhere to the highest patient care and safety standards, including the CDC’s COVID-19 elevated protocols. To that end, we have implemented a number of new initiatives to help you and your patients who are experiencing seizures, or other seizure-like disorders.
Patient Care
We have enhanced our already stringent patient care protocols to include the most up-to-date CDC published guidelines for elevated precautionary measures. A handout is also available for you to provide to patients that voice COVID-19 concerns when you refer them for testing.
The Utility of Video EEG
Video EEG has been demonstrated with respect to serving as the gold standard for the diagnosis of many epilepsy syndromes, identifying mimickers of epilepsy and as the initial evaluation in preparation for eventual resective surgery.
The addition of video recording to long-term EEG recording provides multiple advantages over those done without. For recorded seizures, the video allows the delineation of whether the clinical onset of the event precedes, is concurrent with, or follows the electrographic onset.
At the most basic level, the concurrent video will allow differentiation of paroxysmal non-epileptic seizure-like events (PNES) from true epileptic seizures.
Conversely, if there are clinical events that are characteristic of seizures of frontal lobe origin that may have no scalp EEG correlate, the video may allow their identification where a standard EEG would not.
Quality
Patients monitored by one of our qualified EEG Technologists and interpretation services available by a Board Certified Neurologist.
Convenient
Appointments available within 24 hours of referral. Test results in as little as 7 days and performed in the privacy of the patients’ home.
Affordable
Long-term video EEG monitoring delivered at a fraction of the cost of inpatient monitoring.
