Continuous Electroencephalogram —Necessity or Luxury?

Before the last decade, the critically ill brain was often neglected with regards to direct monitoring and was subjected to systemic targets driven by broad population-based thresholds. Recently, there has been a concerted push from the critical care community to increase noninvasive (and invasive) monitoring in patients with critical illness, especially those with acute brain injury. With the advent of precision medicine extending beyond the world of oncology, the brain has come into focus as a target for individualizing care with advanced neuromonitoring. Continuous electroencephalogram (cEEG) monitoring is being used widely at major medical centers not only for occult seizure detection, but also targeted interventions aimed at preventing or minimizing secondary brain injury (eg, vasospasm detection in subarachnoid hemorrhage) and elucidating injury severity for neuroprognostication. However, a lack of controlled studies showing actual improvement in meaningful outcomes threatens this emerging field that is already confronted by limitations in expertise, resource availability, and fiscal responsibility. Without compelling outcome data, the adage that an absence of evidence may in fact be evidence of absence has the potential to significantly affect the ability to appropriately use advanced technologies, including cEEG and quantitative EEG, for individual patients who need them most.
Source: JAMA Neurology - Category: Neurology Source Type: research