Introduction: In a cohort of adult patients with disturbance of consciousness after TBI, we aimed to explore the relationship of continuous video-EEG (cEEG) versus routine EEG (rEEG) with mortality and functional outcome. Methods: This is a post hoc analysis of a randomized controlled trial (CERTA), in which adults with disorder of consciousness and needing EEG (excluding those with proven seizures/SE just before) were randomized 1:1 to cEEG or two rEEG. In TBI patients, correlation between EEG duration, mortality, and modified Rankin score (mRs, good 0–2) at 6 months was assessed. Results: Among 364 patients, 44 presenting with consciousness impairment after TBI were included; 29 randomized to cEEG and 15 to rEEG. Mortality (p = 0.88) and functional outcome (p = 0.58) at 6 months were similar between groups. There was a nonsignificant tendency toward more seizure/status epilepticus detection with cEEG (p = 0.08). In multivariable regression, cEEG was not related to functional outcome (OR: 0.75 [0.13–4.24], p = 0.745) or mortality (OR: 7.11 [0.51–99.32], p = 0.145). Conclusion: Despite allowing increased seizure detections in TBI patients, cEEG does not seem to be associated with better functional outcome or mortality over rEEG. Pending larger trials, repeated rEEG might be acceptable in post-TBI disorder of consciousness, especially in resource-limited environments.

1.
Langlois
JA
,
Rutland-Brown
W
,
Wald
MM
.
The epidemiology and impact of traumatic brain injury: a brief overview
.
J Head Trauma Rehabil
.
2006
;
21
(
5
):
375
8
.
2.
Murray
GD
,
Butcher
I
,
McHugh
GS
,
Lu
J
,
Mushkudiani
NA
,
Maas
AIR
, et al
.
Multivariable prognostic analysis in traumatic brain injury: results from the IMPACT study
.
J Neurotrauma
.
2007
;
24
(
2
):
329
37
.
3.
Towne
AR
,
Waterhouse
EJ
,
Boggs
JG
,
Garnett
LK
,
Brown
AJ
,
Smith
JR
Jr
, et al
.
Prevalence of nonconvulsive status epilepticus in comatose patients
.
Neurology
.
2000
;
54
(
2
):
340
5
.
4.
Vespa
P
.
Continuous EEG monitoring for the detection of seizures in traumatic brain injury, infarction, and intracerebral hemorrhage: to detect and protect
.
J Clin Neurophysiol
.
2005
;
22
(
2
):
99
106
.
5.
Ronne-Engstrom
E
,
Winkler
T
.
Continuous EEG monitoring in patients with traumatic brain injury reveals a high incidence of epileptiform activity
.
Acta Neurol Scand
.
2006
;
114
(
1
):
47
53
.
6.
Haveman
ME
,
Van Putten
MJAM
,
Hom
HW
,
Eertman-Meyer
CJ
,
Beishuizen
A
,
Tjepkema-Cloostermans
MC
.
Predicting outcome in patients with moderate to severe traumatic brain injury using electroencephalography
.
Crit Care
.
2019
;
23
(
1
):
401
.
7.
Tewarie
PKB
,
Beernink
TMJ
,
Eertman-Meyer
CJ
,
Cornet
AD
,
Beishuizen
A
,
van Putten
MJAM
, et al
.
Early EEG monitoring predicts clinical outcome in patients with moderate to severe traumatic brain injury
.
Neuroimage Clin
.
2023
;
37
:
103350
.
8.
Mikola
A
,
Ratsep
I
,
Sarkela
M
,
Lipping
T
.
Prediction of outcome in traumatic brain injury patients using long-term qEEG features
.
Annu Int Conf IEEE Eng Med Biol Soc
.
2015
;
2015
:
1532
5
.
9.
Tolonen
A
,
Sarkela
MOK
,
Takala
RSK
,
Katila
A
,
Frantzén
J
,
Posti
JP
, et al
.
Quantitative EEG parameters for prediction of outcome in severe traumatic brain injury: development study
.
Clin EEG Neurosci
.
2018
;
49
(
4
):
248
57
.
10.
Vespa
PM
,
Boscardin
WJ
,
Hovda
DA
,
McArthur
DL
,
Nuwer
MR
,
Martin
NA
, et al
.
Early and persistent impaired percent alpha variability on continuous electroencephalography monitoring as predictive of poor outcome after traumatic brain injury
.
J Neurosurg
.
2002
;
97
(
1
):
84
92
.
11.
Thatcher
RW
,
North
DM
,
Curtin
RT
,
Walker
RA
,
Biver
CJ
,
Gomez
JF
, et al
.
An EEG severity index of traumatic brain injury
.
J Neuropsychiatry Clin Neurosci
.
2001
;
13
(
1
):
77
87
.
12.
Rumpl
E
,
Prugger
M
,
Bauer
G
,
Gerstenbrand
F
,
Hackl
JM
,
Pallua
A
.
Incidence and prognostic value of spindles in post-traumatic coma
.
Electroencephalogr Clin Neurophysiol
.
1983
;
56
(
5
):
420
9
.
13.
Westhall
E
,
Rossetti
AO
,
van Rootselaar
AF
,
Wesenberg Kjaer
T
,
investigators
T
,
Horn
J
, et al
.
Standardized EEG interpretation accurately predicts prognosis after cardiac arrest
.
Neurology
.
2016
;
86
(
16
):
1482
90
.
14.
Nolan
JP
,
Sandroni
C
,
Böttiger
BW
,
Cariou
A
,
Cronberg
T
,
Friberg
H
, et al
.
European resuscitation council and European society of intensive care medicine guidelines 2021: post-resuscitation care
.
Intensive Care Med
.
2021
;
47
(
4
):
369
421
.
15.
Claassen
J
,
Taccone
FS
,
Horn
P
,
Holtkamp
M
,
Stocchetti
N
,
Oddo
M
, et al
.
Recommendations on the use of EEG monitoring in critically ill patients: consensus statement from the neurointensive care section of the ESICM
.
Intensive Care Med
.
2013
;
39
(
8
):
1337
51
.
16.
Claassen
J
,
Mayer
SA
,
Kowalski
RG
,
Emerson
RG
,
Hirsch
LJ
.
Detection of electrographic seizures with continuous EEG monitoring in critically ill patients
.
Neurology
.
2004
;
62
(
10
):
1743
8
.
17.
Beuchat
I
,
Rossetti
AO
,
Novy
J
,
Schindler
K
,
Ruegg
S
,
Alvarez
V
.
Continuous versus routine standardized electroencephalogram for outcome prediction in critically ill adults: analysis from a randomized trial
.
Crit Care Med
.
2022
;
50
(
2
):
329
34
.
18.
Grillo
E
.
Concerns about utility and cost-effectiveness of continuous critical-care EEG
.
J Clin Neurophysiol
.
2015
;
32
(
5
):
442
.
19.
Rossetti
AO
,
Lee
JW
.
What’s new on EEG monitoring in the ICU
.
Minerva Anestesiol
.
2021
;
87
(
10
):
1139
45
Epub 2021 Mar 10.
20.
Rossetti
AO
,
Schindler
K
,
Sutter
R
,
Rüegg
S
,
Zubler
F
,
Novy
J
, et al
.
Continuous vs routine electroencephalogram in critically ill adults with altered consciousness and no recent seizure: a multicenter randomized clinical trial
.
JAMA Neurol
.
2020
;
77
(
10
):
1225
32
.
21.
Hirsch
LJ
,
LaRoche
SM
,
Gaspard
N
,
Gerard
E
,
Svoronos
A
,
Herman
ST
, et al
.
American Clinical Neurophysiology Society’s Standardized Critical Care EEG Terminology: 2012 version
.
J Clin Neurophysiol
.
2013
;
30
(
1
):
1
27
.
22.
Le Gall
JR
,
Lemeshow
S
,
Saulnier
F
.
A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study
.
JAMA
.
1993
;
270
(
24
):
2957
63
Erratum in: JAMA 1994 May 4;271(17):1321.
23.
Vespa
PM
,
Miller
C
,
McArthur
D
,
Eliseo
M
,
Etchepare
M
,
Hirt
D
, et al
.
Nonconvulsive electrographic seizures after traumatic brain injury result in a delayed, prolonged increase in intracranial pressure and metabolic crisis
.
Crit Care Med
.
2007
;
35
(
12
):
2830
6
.
24.
Lee
H
,
Mizrahi
MA
,
Hartings
JA
,
Sharma
S
,
Pahren
L
,
Ngwenya
LB
, et al
.
Continuous electroencephalography after moderate to severe traumatic brain injury
.
Crit Care Med
.
2019
;
47
(
4
):
574
82
.
25.
Gaspard
N
,
Manganas
L
,
Rampal
N
,
Petroff
OA
,
Hirsch
LJ
.
Similarity of lateralized rhythmic delta activity to periodic lateralized epileptiform discharges in critically ill patients
.
JAMA Neurol
.
2013
;
70
(
10
):
1288
95
.
26.
Witsch
J
,
Frey
HP
,
Schmidt
JM
,
Velazquez
A
,
Falo
CM
,
Reznik
M
, et al
.
Electroencephalographic periodic discharges and frequency-dependent brain tissue hypoxia in acute brain injury
.
JAMA Neurol
.
2017
;
74
(
3
):
301
9
.
27.
Sutter
R
,
Kaplan
PW
,
Rüegg
S
.
Outcome predictors for status epilepticus: what really counts
.
Nat Rev Neurol
.
2013
;
9
(
9
):
525
34
.
28.
Hartings
JA
,
Wilson
JA
,
Hinzman
JM
,
Pollandt
S
,
Dreier
JP
,
DiNapoli
V
, et al
.
Spreading depression in continuous electroencephalography of brain trauma
.
Ann Neurol
.
2014
;
76
(
5
):
681
94
.
29.
Chase
A
.
Traumatic brain injury: spreading depolarization can cause secondary injury after TBI
.
Nat Rev Neurol
.
2014
;
10
(
10
):
547
.
30.
McNett
M
,
Amato
S
,
Gianakis
A
,
Grimm
D
,
Philippbar
SA
,
Belle
J
, et al
.
The FOUR score and GCS as predictors of outcome after traumatic brain injury
.
Neurocrit Care
.
2014
;
21
(
1
):
52
7
.
31.
Raj
R
,
Skrifvars
M
,
Bendel
S
,
Selander
,
T
,
Kivisaari
,
R
,
Siironen
,
J
, et al
.
Predicting six-month mortality of patients with traumatic brain injury: usefulness of common intensive care severity scores
.
Crit Care
.
2014
;
18
(
2
):
R60
.
32.
Cronberg
T
,
Greer
DM
,
Lilja
G
,
Moulaert
V
,
Swindell
P
,
Rossetti
AO
.
Brain injury after cardiac arrest: from prognostication of comatose patients to rehabilitation
.
Lancet Neurol
.
2020
;
19
(
7
):
611
22
.
33.
Wang
J
,
Huang
L
,
Ma
X
,
Zhao
C
,
Liu
J
,
Xu
D
.
Role of quantitative EEG and EEG reactivity in traumatic brain injury
.
Clin EEG Neurosci
.
2022
;
53
(
5
):
452
9
.
34.
Dericioglu
N
,
Khasiyev
F
,
Arsava
EM
,
Topcuoglu
MA
.
Frontal intermittent rhythmic delta activity (FIRDA) in the neurological intensive care: prevalence, determinants, and clinical significance
.
Clin EEG Neurosci
.
2018
;
49
(
4
):
272
7
.
35.
Urbano
V
,
Alvarez
V
,
Schindler
K
,
Rüegg
S
,
Ben-Hamouda
N
,
Novy
J
, et al
.
Continuous versus routine EEG in patients after cardiac arrest: analysis of a randomized controlled trial (CERTA)
.
Resuscitation
.
2022
;
176
:
68
73
.
You do not currently have access to this content.