Point-of-Care EEG Is Coming to the Emergency Department
By James Syrett, MD
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on July 7, 2026
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For a patient in non-convulsive status it takes over 12 hours before I get concerned about any lasting effects on brain function, but the level of damage varies. It can even be non-existent. I have had patients in nonconvulsive status for up to a week or longer who simply woke up one day and were just fine. The major cause of mortality to seizure patients is respiratory failure, but the emergency physician is already the expert at airway protection via intubation if needed. With all that said, a full electrode complement is better than just 12.
Instead of focusing on EEG, I think epileptologists should work with emergency physicians to help them better identify psychogenic non-epileptic seizures, myoclonic activity from anoxic brain injury, and how to maximize the efficacy of antiepileptic drugs in patients with status epilepticus. If you can focus on those cohorts, which constitute a large number of people who get transferred for continuous EEG, you’ll end up filtering a large portion of people who weren’t actually in status epilepticus and never needed an epileptologist’s EEG.
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Dr. Smart is an associate professor of neurology at McGovern Medical School,(MMS) division head for inpatient neurology and medical director of the Neurohospitalist Fellowship Program at MMS at the University of Texas (UT) Health in Houston and director of continuous EEG operations at UT Health Science Center and Memorial Herman Hospital at Texas Medical Center.[/sidebar]
Earlier diagnosis matters, especially when the seizure is not clinically obvious. When electrographic seizure activity continues unrecognized, the brain remains under physiologic stress longer and becomes more difficult to control. Point-of-care EEG therefore brings the answer closer to the moment when treatment decisions matter most.
A second major area of relevance is the post-cardiac arrest patient. These patients often remain unresponsive after return of spontaneous circulation, and the differential includes ongoing seizure activity, diffuse cerebral injury, medication effect, and delayed recovery. EEG is now important in this population not only for seizure detection, but also as part of structured neurologic assessment, and it has been incorporated into updated American Heart Association guidance for post-cardiac arrest management. For emergency and ICU physicians, that means EEG is no longer something that belongs later in the ICU course. It is becoming part of the early evaluation in post-arrest patients whose neurologic status remains uncertain.
A third emerging area is stroke and focal cerebral dysfunction. Stroke will remain an imaging-driven pathway, but cerebral ischemia produces electrophysiologic changes. There is increasing interest in whether portable EEG can help identify localized decreases in cerebral activity, support early triage, or complement evaluation in the field and ED. This remains an evolving area rather than standard practice, but points toward a broader future role for EEG in frontline neurologic care.
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