Resident Use of EEG Cap System to Rule Out Nonconvulsive Status Epilepticus.

BACKGROUND: Nonconvulsive status epilepticus (NCSE) requires an EEG for diagnosis and in many centers access may be limited. The authors aimed to test whether neurology residents can be trained to use and interpret full-montage EEGs using an EEG cap electrode system to detect NCSE while on-call. METHODS: Neurology residents were trained to interpret EEG recordings using the American Clinical Neurophysiology Society critical care EEG terminology. Residents who achieved a score of 70% or higher in the American Clinical Neurophysiology Society certification test and attended a training session were eligible to use the EEG cap on-call with patients suspected of having NCSE. Residents' experience and interpretation of observed EEG patterns were evaluated using a questionnaire. Each EEG recording was independently reviewed by three epilepsy specialists to determine the interpretability of each study and whether the residents correctly identified the EEG patterns. RESULTS: Sixteen residents undertook the training and 12 (75%) achieved a score of 70% or higher on the certification test. Seven of these residents performed 14 EEG cap studies between August 2017 and May 2018. The percent agreement between residents and electroencephalographers was 78.6% for EEG interpretability and 57.1% for description of EEG pattern. Residents did not miss any malignant patterns concerning for NCSE, which accounted for 1 of 14 EEGs but "overcalled" patterns as malignant in 3 of 14 recordings. CONCLUSIONS: This study suggests that neurology residents can be taught to perform and interpret EEGs using a cap system to monitor for NCSE. Additional training will help improve EEG interpretation and sensitivity.

Pan-viral serology implicates enteroviruses in acute flaccid myelitis.

Since 2012, the United States of America has experienced a biennial spike in pediatric acute flaccid myelitis (AFM)1-6. Epidemiologic evidence suggests non-polio enteroviruses (EVs) are a potential etiology, yet EV RNA is rarely detected in cerebrospinal fluid (CSF)2. CSF from children with AFM (n = 42) and other pediatric neurologic disease controls (n = 58) were investigated for intrathecal antiviral antibodies, using a phage display library expressing 481,966 overlapping peptides derived from all known vertebrate and arboviruses (VirScan). Metagenomic next-generation sequencing (mNGS) of AFM CSF RNA (n = 20 cases) was also performed, both unbiased sequencing and with targeted enrichment for EVs. Using VirScan, the viral family significantly enriched by the CSF of AFM cases relative to controls was Picornaviridae, with the most enriched Picornaviridae peptides belonging to the genus Enterovirus (n = 29/42 cases versus 4/58 controls). EV VP1 ELISA confirmed this finding (n = 22/26 cases versus 7/50 controls). mNGS did not detect additional EV RNA. Despite rare detection of EV RNA, pan-viral serology frequently identified high levels of CSF EV-specific antibodies in AFM compared with controls, providing further evidence for a causal role of non-polio EVs in AFM.