• Chusak Limotai, Suda Jirasakuldej, Sattawut Wongwiangiunt, Tipakorn Tumnark, Piradee Suwanpakdee, Kwuanrat Wangponpattanasiri, Piyanuch Rakchue, Chaiwiwat Tungkasereerak, Polchai Pleumpanupatand, Phopsuk Tansuhaj, Phattarawin Ekkachon, Songchai Kittipanprayoon, Apiwoot Kerddonfag, Thippamas Pobsuk, Anuchate Pattanateepapon, Kammant Phanthumchinda, Nijasri C Suwanwela, Iyavut Thaipisuttikul, Kanokwan Boonyapisit, Atiporn Ingsathit, Oraluck Pattanaprateep, John Attia, Gareth J McKay, Andrea O Rossetti, Ammarin Thakkinstian, Chutima Rukrung, Patcharapun Kangsananont, Jeerawan Mokkaew, Nittaya Phayaph, Supak Pukpraman, Warangkana Ritrhathon, Youwarat Jarungjitapinan, Jintana Pinpradab, Netphit Khamhoi, Mayuree Nookaew, Patchareeporn Chauywang, Pichai Rojdmapitayakorn, Paworamon Sribussara, Wasunon Tinroongroj, Wisan Teeratantikanon, Tabtim Chongsuvivatwong, Watchara Viratyaporn, Witoon Jantararotai, Komkrit Panyawattanakit, Nopparat Rujirarongrueng, Pornnapat Damthong, Pattama Udom, Molvipa Siengsuwan, Phatcharamai Phonprasori, Karnpidcha Wanmuang, Nattawut Unwanatham, Sasivimol Rattanasiri, Kunlawat Thadanipon, Panutchaya Noivong, Sirincha Pitipanyakul, Watchara Rattanachaisit, Wichuta Muangthong, Rachasiri Wittayawisawasakul, Sunisa Deerassamee, Wannaporn Ruayruen, Supinya Homgrunjarut, Yupapron Ledprased, Maturos Pankong, and Pentip Rattanayuvakorn.
• Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Rama VI Road, Rachatevi, Bangkok, 10400, Thailand.
• Crit Care. 2025 Jan 7; 29 (1): 1515.

BackgroundContinuous electroencephalography (cEEG) has been recommended in critically ill patients although its efficacy for improving patients' functional status remains unclear. This study aimed to compare the efficacy of Tele-cEEG with Tele-routine EEG (Tele-rEEG), in terms of seizure detection rate, mortality and functional outcomes.MethodsThis study is a 3-year randomized, controlled, parallel, multicenter trial, conducted in eight regional hospitals across Thailand. Eligible participants were critically ill patients aged ≥ 15 years and at-risk for developing nonconvulsive seizure (NCS)/nonconvulsive status epilepticus (NCSE). Study interventions were 24-72 h Tele-cEEG versus 30-min Tele-rEEG. Study outcomes were seizure detection rate, mortality and functional outcomes (mRS), assessed at hospital discharge, ≤ 7 days, 3-, 6-, 9-months and 1 year.ResultsTwo hundred and fifty-four patients were randomized, 128 and 126 patients received Tele-cEEG and Tele-rEEG, respectively. NCS/NCSE were detected more commonly in the Tele-cEEG (21.88%) than Tele-rEEG arm (14.29%) but this was not statistically significant (p = 0.116). Intention-to-treat, per-protocol and as-treated analysis showed non-significant differences in mortality at all assessment periods, with corresponding mortality rates of 10.03% (Tele-cEEG) versus 10.10% (Tele-rEEG) (p = 0.894), 9.67% versus 9.06% (p = 0.833) and 10.34% versus 9.06% (p = 0.600), respectively. Functional outcome was also not significantly different in all analyses.ConclusionsBoth Tele-cEEG and Tele-rEEG are feasible, although Tele-EEG requires additional EEG specialists, budget, and computational resources. While Tele-cEEG may help detect NCS/NCSE, this study had limited power to detect its efficacy in reducing mortality or improving functional outcomes. In limited-resource settings, Tele-rEEG approximating 30 min or longer offers a feasible and potentially valuable initial screening tool for critically ill patients at-risk of seizures. However, where Tele-cEEG is readily available, it remains the recommended approach. Trial registration Thai Clinical Trials Registry (TTCTR20181022002); Registered 22 October 2018.© 2025. The Author(s).

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