Abstracts

Rationale: Nonconvulsive status epilepticus (NCSE) is a neurological emergency, which requires an electroencephalogram (EEG) for diagnosis. Outside daytime hours, in some centers with lower resources, neurology residents perform and interpret EEG studies such as previously described subhairline montage EEGs¹. Our goal was to determine if neurology residents could be trained to perform full 10-20 EEG studies while on call as well as document their perceptions of this experience. To our knowledge, this is the first report of neurology residents being trained to perform and interpret full 10-20 EEG studies in the literature. Methods: This study was approved by our institutional review board. Sixteen adult neurology residents (PGY 2-4) previously completed training in the ACNS critical care EEG terminology and wrote the certification test (ref other abstract). All residents additionally received a 2-hour training session on the application of an EEG cap system (Electro-Cap Intl., Ohio, U.S/ Natus Medical, Grass EEG system, California, U.S) (Figure 1). Residents who passed the certification test and who attended the EEG cap training were eligible to use the EEG cap during their call hours on patients they suspected to be at risk for nonconvulsive status epilepticus. To gain a comprehensive understanding of the residents’ perspective, a short questionnaire was administered to each resident after each EEG performed. Using Likert scale items (agree, strongly agree, disagree, strongly disagree and don’t know) the questionnaire focused on whether the residents felt proficient in setting up the machine and obtaining the recording as well as whether they felt this impacted their management. The questionnaire also asked them to rate the pattern observed on the recording using the following designations: “benign”, “ictal-interictal continuum”, “malignant”. Descriptive  statistics  were  used  to  characterize  our  cohort’s answers, including medians  for  non-parametric  data. Results: Twelve residents at various stages of residency training (Figure 2) performed 14 separate EEG cap studies between August 2017 and May 2018. The median time to set up and start recording an EEG using the cap system was 50 minutes (IQR 20, 60). A combined 71.4 % of residents agreed or strongly agreed that the set up was easy and 92.9% agreed or strongly agreed that the EEG obtained was interpretable. 100 % agreed or strongly agreed that the access to EEG was useful during their call coverage and 85.7% agreed or strongly agreed that the EEG data changed their management. Of the patterns observed, 57.1% were reported to be benign, 14.3% on the ictal-interictal continuum and 28.6% were reported to be malignant. Conclusions: In this study we show that, with minimal training, adult neurology residents at various stages of residency feel confident about performing full montage cap EEGs on their own during off hours. Additionally, their perceptions of the experience appear overwhelmingly positive. In summary, our study suggests that adult neurology residents can perform EEGs to answer important clinical questions in low resource settings when EEG technologists are not available. Funding: None