Does Continuous EEG Offer an Advantage Over Routine EEG?

TOPLINEAmong critically ill patients without a primary neurologic injury, continuous EEG (cEEG) monitoring showed no advantage over routine EEG (rEEG) in terms of long-term mortality, functional outcomes, or the detection of seizures and epileptiform activity.METHODOLOGYResearchers conducted a post hoc analysis of a multicentre, randomised trial to assess whether cEEG, compared with rEEG, is associated with improved clinical outcomes among critically ill patients without a primary neurologic condition.The analysis included a total of 76 critically ill patients (mean age, 65.3 years; 29% women) without a primary neurologic condition. Patients were randomly assigned to undergo either cEEG monitoring for 30-48 hours (n = 34) or two rEEG recordings of 20-30 minutes each (n = 42).EEGs were interpreted by trained and certified epileptologists according to the standardised criteria.Mortality and functional outcomes were evaluated at 6 months; Cerebral Performance Category scores of 1-2 were classified as favourable outcomes.The researchers also assessed seizure detection, rhythmic or periodic EEG patterns, ictal-interictal continuum features, antiseizure medication changes, and infections within 4 weeks.TAKEAWAYAt 6 months, rates of mortality (41% vs 38%; P = .970) and favourable neurologic outcomes (47% vs 43%; P = .893) did not differ significantly between cEEG and rEEG groups.No seizures or status epilepticus was detected in either group during monitoring.Sleep spindles were significantly more common in the cEEG group than in the rEEG group (50% vs 19%; P = .009).Rates of rhythmic or periodic patterns, ictal-interictal continuum features, sporadic epileptiform discharges, antiseizure medication changes, and infections within 4 weeks did not differ significantly between the two groups.IN PRACTICE"[R]epeated rEEG may represent, particularly in resource-limited settings, a reasonable approach in critically ill adults without primary neurologic injury or recent clinical seizures/status epilepticus and undergoing EEG for unexplained altered mental status since seizures appear to be very uncommon in this population," the authors wrote.SOURCEThis study was led by Gregory Lepeu, Centre Hospitalier Universitaire Vaudois and Lausanne University Hospital, Lausanne, Switzerland. It was published online on September 28, 2026, in the European Journal of Neurology.LIMITATIONSThe post hoc design restricted causal interpretation. Patients with recent seizures or status epilepticus were excluded, which limited generalisability. The parent trial did not capture the clinical signs prompting EEG referral.DISCLOSURESFunding information was not provided for the study. The authors declared having no conflicts of interest.This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.