1
|
Kim JY, Shin J, Kim L, Kim SH. Electroencephalography characteristics related to risk of sudden unexpected death in epilepsy in patients with Dravet syndrome. Front Neurol 2023; 14:1222721. [PMID: 37745659 PMCID: PMC10512954 DOI: 10.3389/fneur.2023.1222721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/22/2023] [Indexed: 09/26/2023] Open
Abstract
Objective To investigate the quantitative electroencephalography (EEG) features associated with a high risk of sudden unexpected death in epilepsy (SUDEP) in patients with Dravet syndrome (DS). Methods Patients with DS and healthy controls (HCs) who underwent EEG were included in the study. EEG signals were recorded using a 21 channel digital EEG system, and pre-processed data were analyzed to identify quantitative EEG features associated with a high SUDEP risk. To assess the risk of SUDEP, SUDEP-7 scores were used. Results A total of 64 patients with DS [38 males and 26 females, aged: 128.51 ± 75.50 months (range: 23-380 months)], and 13 HCs [7 males and 6 females, aged: 95.46 ± 86.48 months (range: 13-263 months)] were included. For the absolute band power, the theta power was significantly higher in the high-SUDEP group than in the low-SUDEP group in the central brain region. For the relative band power, the theta power was also significantly higher in the high-SUDEP group than in the low-SUDEP group in the central and occipital brain regions. The alpha power was significantly lower in the high-SUDEP group than in the low-SUDEP group in the central and parietal brain regions. Conclusion Patients with high SUDEP-7 scores have different EEG features from those with low SUDEP-7 scores, suggesting that EEG may be used as a biomarker of SUDEP in DS. Significance Early intervention in patients with DS at a high risk of SUDEP can reduce mortality and morbidity. Patients with high theta band powers warrant high-level supervision.
Collapse
Affiliation(s)
- Jeong-Youn Kim
- Electronics and Telecommunication Research Institute (ETRI), Daejeon, Republic of Korea
| | - Jeongyoon Shin
- School of Electrical and Electronic Engineering, College of Engineering, Yonsei University, Seoul, Republic of Korea
- Yonsei Biomedical Research Institute, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Laehyun Kim
- Center for Bionics, Korea Institute of Science and Technology, Seoul, Republic of Korea
- Department of HY-KIST Bio-Convergence, Hanyang University, Seoul, Republic of Korea
| | - Se Hee Kim
- Pediatric Neurology, Department of Pediatrics, Epilepsy Research Institute, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
2
|
Kaffka genaamd Dengler SE, Vervoorn MT, Brouwer M, de Jonge J, van der Kaaij NP. Dilemmas concerning heart procurement in controlled donation after circulatory death. Front Cardiovasc Med 2023; 10:1225543. [PMID: 37583588 PMCID: PMC10424927 DOI: 10.3389/fcvm.2023.1225543] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 07/11/2023] [Indexed: 08/17/2023] Open
Abstract
With an expanding population at risk for heart failure and the resulting increase in patients admitted to the waiting list for heart transplantation, the demand of viable organs exceeds the supply of suitable donor hearts. Use of hearts after circulatory death has reduced this deficit. Two primary techniques for heart procurement in circulatory death donors have been described: direct procurement and perfusion and thoraco-abdominal normothermic regional perfusion. While the former has been accepted as an option for heart procurement in circulatory death donors, the latter technique has raised some ethical questions in relation to the dead donor rule. In this paper we discuss the current dilemmas regarding these heart procurement protocols in circulatory death donors.
Collapse
Affiliation(s)
| | - M. T. Vervoorn
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - M. Brouwer
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - J. de Jonge
- Department of Surgery, Erasmus Medical Center Transplant Institute, Rotterdam, Netherlands
| | - N. P. van der Kaaij
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| |
Collapse
|
3
|
Charpier S. Between life and death: the brain twilight zones. Front Neurosci 2023; 17:1156368. [PMID: 37260843 PMCID: PMC10227869 DOI: 10.3389/fnins.2023.1156368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/24/2023] [Indexed: 06/02/2023] Open
Abstract
Clinically, and legally, death is considered a well-defined state of the organism characterized, at least, by a complete and irreversible cessation of brain activities and functions. According to this pragmatic approach, the moment of death is implicitly represented by a discrete event from which all cerebral processes abruptly cease. However, a growing body of experimental and clinical evidence has demonstrated that cardiorespiratory failure, the leading cause of death, causes complex time-dependent changes in neuronal activity that can lead to death but also be reversed with successful resuscitation. This review synthesizes our current knowledge of the succeeding alterations in brain activities that accompany the dying and resuscitation processes. The anoxia-dependent brain defects that usher in a process of potential death successively include: (1) a set of changes in electroencephalographic (EEG) and neuronal activities, (2) a cessation of brain spontaneous electrical activity (isoelectric state), (3) a loss of consciousness whose timing in relation to EEG changes remains unclear, (4) an increase in brain resistivity, caused by neuronal swelling, concomitant with the occurrence of an EEG deviation reflecting the neuronal anoxic insult (the so-called "wave of death," or "terminal spreading depolarization"), followed by, (5) a terminal isoelectric brain state leading to death. However, a timely restoration of brain oxygen supply-or cerebral blood flow-can initiate a mirrored sequence of events: a repolarization of neurons followed by a re-emergence of neuronal, synaptic, and EEG activities from the electrocerebral silence. Accordingly, a recent study has revealed a new death-related brain wave: the "wave of resuscitation," which is a marker of the collective recovery of electrical properties of neurons at the beginning of the brain's reoxygenation phase. The slow process of dying still represents a terra incognita, during which neurons and neural networks evolve in uncertain states that remain to be fully understood. As current event-based models of death have become neurophysiologically inadequate, I propose a new mixed (event-process) model of death and resuscitation. It is based on a detailed description of the different phases that succeed each other in a dying brain, which are generally described separately and without mechanistic linkage, in order to integrate them into a continuum of declining brain activity. The model incorporates cerebral twilight zones (with still unknown neuronal and synaptic processes) punctuated by two characteristic cortical waves providing real-time biomarkers of death- and resuscitation.
Collapse
Affiliation(s)
- Stéphane Charpier
- Sorbonne Université, Institut du Cerveau – Paris Brain Institute - ICM, Inserm, CNRS, APHP, Hôpital de la Pitié-Salpêtriére, Paris, France
- Sorbonne University, UPMC Université Paris, Paris, France
| |
Collapse
|
4
|
Zhou L, Chen Y, Liu Z, You J, Chen S, Liu G, Yu Y, Wang J, Chen X. A predictive model for consciousness recovery of comatose patients after acute brain injury. Front Neurosci 2023; 17:1088666. [PMID: 36845443 PMCID: PMC9945265 DOI: 10.3389/fnins.2023.1088666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/23/2023] [Indexed: 02/10/2023] Open
Abstract
Background Predicting the consciousness recovery for comatose patients with acute brain injury is an important issue. Although some efforts have been made in the study of prognostic assessment methods, it is still unclear which factors can be used to establish model to directly predict the probability of consciousness recovery. Objectives We aimed to establish a model using clinical and neuroelectrophysiological indicators to predict consciousness recovery of comatose patients after acute brain injury. Methods The clinical data of patients with acute brain injury admitted to the neurosurgical intensive care unit of Xiangya Hospital of Central South University from May 2019 to May 2022, who underwent electroencephalogram (EEG) and auditory mismatch negativity (MMN) examinations within 28 days after coma onset, were collected. The prognosis was assessed by Glasgow Outcome Scale (GOS) at 3 months after coma onset. The least absolute shrinkage and selection operator (LASSO) regression analysis was applied to select the most relevant predictors. We combined Glasgow coma scale (GCS), EEG, and absolute amplitude of MMN at Fz to develop a predictive model using binary logistic regression and then presented by a nomogram. The predictive efficiency of the model was evaluated with AUC and verified by calibration curve. The decision curve analysis (DCA) was used to evaluate the clinical utility of the prediction model. Results A total of 116 patients were enrolled for analysis, of which 60 had favorable prognosis (GOS ≥ 3). Five predictors, including GCS (OR = 13.400, P < 0.001), absolute amplitude of MMN at Fz site (FzMMNA, OR = 1.855, P = 0.038), EEG background activity (OR = 4.309, P = 0.023), EEG reactivity (OR = 4.154, P = 0.030), and sleep spindles (OR = 4.316, P = 0.031), were selected in the model by LASSO and binary logistic regression analysis. This model showed favorable predictive power, with an AUC of 0.939 (95% CI: 0.899-0.979), and calibration. The threshold probability of net benefit was between 5% and 92% in the DCA. Conclusion This predictive model for consciousness recovery in patients with acute brain injury is based on a nomogram incorporating GCS, EEG background activity, EEG reactivity, sleep spindles, and FzMMNA, which can be conveniently obtained during hospitalization. It provides a basis for care givers to make subsequent medical decisions.
Collapse
Affiliation(s)
- Liang Zhou
- Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China
| | - Yuanyi Chen
- Central of Stomatology, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Ziyuan Liu
- Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China
| | - Jia You
- Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China
| | - Siming Chen
- Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China
| | - Ganzhi Liu
- Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China
| | - Yang Yu
- College of Intelligence Science and Technology, National University of Defense Technology, Changsha, Hunan, China
| | - Jian Wang
- Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China,*Correspondence: Jian Wang,
| | - Xin Chen
- Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China,Xin Chen,
| |
Collapse
|
5
|
Martinez P, Sheikh I, Westover MB, Zafar SF. Implications of stimulus-induced, rhythmic, periodic, or ictal discharges (SIRPIDs) in hospitalized patients. Front Neurol 2023; 13:1062330. [PMID: 36756343 PMCID: PMC9899805 DOI: 10.3389/fneur.2022.1062330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/29/2022] [Indexed: 01/24/2023] Open
Abstract
Background Stimulus-induced electroencephalographic (EEG) patterns are commonly seen in acutely ill patients undergoing continuous EEG monitoring. Despite ongoing investigations, the pathophysiology, therapeutic and prognostic significance of stimulus-induced rhythmic, periodic or ictal discharges (SIRPIDs) and how it applies to specific pathologies remain unclear. We aimed to investigate the clinical implications of SIRPIDs in hospitalized patients. Methods This is a retrospective single-center study of hospitalized patients from May 2016 to August 2017. We included patients above the age of 18 years who underwent >16 h of EEG monitoring during a single admission. We excluded patients with cardiac arrest and anoxic brain injury. Demographic data were obtained as well as admission GCS, and discharge modified Rankin Score (mRS). EEGs were reviewed for background activity in addition to epileptiform, periodic, and rhythmic patterns. The presence or absence of SIRPIDs was recorded. Our outcome was discharge mRS defined as good outcome, mRS 0-4, and poor outcome mRS, 5-6. Results A total of 351 patients were included in the final analysis. The median age was 63 years and 175 (50%) were women. SIRPIDs were identified in 82 patients (23.4%). Patients with SIRPIDs had a median initial GCS of 12 (IQR, 6-15) and a length of stay of 12 days (IQR, 6-15). They were more likely to have absent posterior dominant rhythm, decreased reactivity, and more likely to have spontaneous periodic and rhythmic patterns and higher frequency of burst suppression. After adjusting for baseline clinical variables, underlying disease type and severity, and EEG background features, the presence of SIRPIDs was also associated with poor outcomes classified as MRS 5 or 6 (OR 4.75 [2.74-8.24] p ≤ 0.0001). Conclusion In our cohort of hospitalized patients excluding anoxic brain injury, SIRPIDs were identified in 23.4% and were seen most commonly in patients with primary systemic illness. We found SIRPIDs were independently associated with poor neurologic outcomes. Several studies are indicated to validate these findings and determine the risks vs. benefits of anti-seizure treatment.
Collapse
|
6
|
Frohlich J, Chiang JN, Mediano PAM, Nespeca M, Saravanapandian V, Toker D, Dell'Italia J, Hipp JF, Jeste SS, Chu CJ, Bird LM, Monti MM. Neural complexity is a common denominator of human consciousness across diverse regimes of cortical dynamics. Commun Biol 2022; 5:1374. [PMID: 36522453 PMCID: PMC9755290 DOI: 10.1038/s42003-022-04331-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
What is the common denominator of consciousness across divergent regimes of cortical dynamics? Does consciousness show itself in decibels or in bits? To address these questions, we introduce a testbed for evaluating electroencephalogram (EEG) biomarkers of consciousness using dissociations between neural oscillations and consciousness caused by rare genetic disorders. Children with Angelman syndrome (AS) exhibit sleep-like neural dynamics during wakefulness. Conversely, children with duplication 15q11.2-13.1 syndrome (Dup15q) exhibit wake-like neural dynamics during non-rapid eye movement (NREM) sleep. To identify highly generalizable biomarkers of consciousness, we trained regularized logistic regression classifiers on EEG data from wakefulness and NREM sleep in children with AS using both entropy measures of neural complexity and spectral (i.e., neural oscillatory) EEG features. For each set of features, we then validated these classifiers using EEG from neurotypical (NT) children and abnormal EEGs from children with Dup15q. Our results show that the classification performance of entropy-based EEG biomarkers of conscious state is not upper-bounded by that of spectral EEG features, which are outperformed by entropy features. Entropy-based biomarkers of consciousness may thus be highly adaptable and should be investigated further in situations where spectral EEG features have shown limited success, such as detecting covert consciousness or anesthesia awareness.
Collapse
Affiliation(s)
- Joel Frohlich
- Department of Psychology, University of California Los Angeles, 90095, Pritzker Hall, Los Angeles, CA, USA.
- Institute for Neuromodulation and Neurotechnology, University Hospital and University of Tuebingen, Tuebingen, Germany.
| | - Jeffrey N Chiang
- Department of Computational Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Pedro A M Mediano
- Department of Computing, Imperial College London, London, UK
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Mark Nespeca
- Department of Neurosciences, University of California San Diego, San Diego, CA, USA
- Department of Neurology, Rady Children's Hospital San Diego, San Diego, CA, USA
| | - Vidya Saravanapandian
- Center for Autism Research and Treatment, University of California Los Angeles, Semel Institute for Neuroscience, Los Angeles, CA, USA
| | - Daniel Toker
- Department of Psychology, University of California Los Angeles, 90095, Pritzker Hall, Los Angeles, CA, USA
| | - John Dell'Italia
- Institute for Advanced Consciousness Studies, Santa Monica, CA, USA
| | - Joerg F Hipp
- Roche Pharma Research and Early Development, Neuroscience and Rare Diseases, Roche Innovation Center Basel, Basel, Switzerland
| | - Shafali S Jeste
- Center for Autism Research and Treatment, University of California Los Angeles, Semel Institute for Neuroscience, Los Angeles, CA, USA
- Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Catherine J Chu
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lynne M Bird
- Department of Pediatrics, University of California San Diego, San Diego, CA, USA
- Division of Genetics/Dysmorphology, Rady Children's Hospital - San Diego, San Diego, CA, USA
| | - Martin M Monti
- Department of Psychology, University of California Los Angeles, 90095, Pritzker Hall, Los Angeles, CA, USA
- Deptment of Neurosurgery, UCLA Brain Injury Research Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
7
|
Wang J, Chen X, Zhou L, Liu ZY, Xia YG, You J, Lan S, Liu JF. Assessment of electroencephalography and event-related potentials in unresponsive patients with brain injury. Neurophysiol Clin 2022; 52:384-393. [PMID: 36008205 DOI: 10.1016/j.neucli.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 07/25/2022] [Accepted: 07/25/2022] [Indexed: 10/15/2022] Open
Abstract
OBJECTIVE To investigate the predictors of clinical outcomes in unresponsive patients with acquired brain injuries. METHODS Patients with coma or disorders of consciousness were enrolled from August 2019 to March 2021. A retrospective analysis of demographics, etiology, clinical score, diagnosis, electroencephalography (EEG), and event-related potential (ERP) data from 1 week to 2 months after coma onset was conducted. Findings were assessed for predicting favorable outcomes at 6 months post-coma, and functional outcomes were determined using the Glasgow Outcome Scale-Extended (GOS-E). RESULTS Of 68 patients, 22 patients had a good neurological outcome at 6 months, while 11 died. Univariate analysis showed that motor response (Motor-R; p < 0.001), EEG pattern (p = 0.015), sleep spindles (p = 0.018), EEG reactivity (EEG-R; p < 0.001), mismatch negativity (MMN) amplitude at electrode Fz (FzMMNA; p = 0.001), P3a latency (p = 0.044), and P3a amplitude at electrode Cz (CzP3aA; p < 0.001) were significantly correlated with patient prognosis. Multivariable logistic regression analysis showed that FzMMNA, CzP3aA, EEG-R, and Motor-R were significant independent predictors of a favorable outcome. The sensitivity and specificity of FzMMNA (dichotomized at 1.16 μV) were 86.4% and 58.5%, and of CzP3aA (cut-off value 2.76 μV) were 90.9% and 70.7%, respectively. ERP amplitude (ERP-A), a combination of FzMMNA and CzP3aA, improved prediction accuracy, with an area under the receiver operating characteristic curve (AUC) of 0.884. A model incorporating Motor-R, EEG-R, and ERP-A yielded an outstanding predictive performance (AUC=0.921) for a favorable outcome. CONCLUSION ERP-A and the prognostic model resulted in the efficient prediction of a favorable outcome in unresponsive patients.
Collapse
Affiliation(s)
- Jian Wang
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, PR China, 410008
| | - Xin Chen
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, PR China, 410008
| | - Liang Zhou
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, PR China, 410008
| | - Zi-Yuan Liu
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, PR China, 410008
| | - Yu-Guo Xia
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, PR China, 410008
| | - Jia You
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, PR China, 410008
| | - Song Lan
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, PR China, 410008
| | - Jin-Fang Liu
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, PR China, 410008.
| |
Collapse
|
8
|
State-dependent effects of neural stimulation on brain function and cognition. Nat Rev Neurosci 2022; 23:459-475. [PMID: 35577959 DOI: 10.1038/s41583-022-00598-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 01/02/2023]
Abstract
Invasive and non-invasive brain stimulation methods are widely used in neuroscience to establish causal relationships between distinct brain regions and the sensory, cognitive and motor functions they subserve. When combined with concurrent brain imaging, such stimulation methods can reveal patterns of neuronal activity responsible for regulating simple and complex behaviours at the level of local circuits and across widespread networks. Understanding how fluctuations in physiological states and task demands might influence the effects of brain stimulation on neural activity and behaviour is at the heart of how we use these tools to understand cognition. Here we review the concept of such 'state-dependent' changes in brain activity in response to neural stimulation, and consider examples from research on altered states of consciousness (for example, sleep and anaesthesia) and from task-based manipulations of selective attention and working memory. We relate relevant findings from non-invasive methods used in humans to those obtained from direct electrical and optogenetic stimulation of neuronal ensembles in animal models. Given the widespread use of brain stimulation as a research tool in the laboratory and as a means of augmenting or restoring brain function, consideration of the influence of changing physiological and cognitive states is crucial for increasing the reliability of these interventions.
Collapse
|
9
|
Leota J, Kleinert T, Tran A, Nash K. Neural signatures of heterogeneity in risk-taking and strategic consistency. Eur J Neurosci 2021; 54:7214-7230. [PMID: 34561929 PMCID: PMC9292925 DOI: 10.1111/ejn.15476] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/23/2021] [Accepted: 09/20/2021] [Indexed: 12/28/2022]
Abstract
People display a high degree of heterogeneity in risk-taking behaviour, but this heterogeneity remains poorly understood. Here, we use a neural trait approach to examine if task-independent, brain-based differences can help uncover the sources of heterogeneity in risky decision-making. We extend prior research in two key ways. First, we disentangled risk-taking and strategic consistency using novel measures afforded by the Balloon Analogue Risk Task. Second, we applied a personality neuroscience framework to explore why personality traits are typically only weakly related to risk-taking behaviour. We regressed participants' (N = 104) source localized resting-state electroencephalographic activity on risk-taking and strategic consistency. Results revealed that higher levels of resting-state delta-band current density (reflecting reduced cortical activation) in the left dorsal anterior cingulate cortex and the left dorsolateral prefrontal cortex were associated with increased risk-taking and decreased strategic consistency, respectively. These results suggest that heterogeneity in risk-taking behaviour is associated with neural dispositions related to sensitivity to the risk of loss, whereas heterogeneity in strategic consistency is associated with neural dispositions related to strategic decision-making. Finally, extraversion, neuroticism, openness, and self-control were broadly associated with both of the identified neural traits, which in turn mediated indirect associations between personality traits and behavioural measures. These results provide an explanation for the weak direct relationships between personality traits and risk-taking behaviour, supporting a personality neuroscience framework of traits and decision-making.
Collapse
Affiliation(s)
- Josh Leota
- Department of Psychology, University of Alberta, Edmonton, Alberta, Canada
| | - Tobias Kleinert
- Department of Psychology, University of Alberta, Edmonton, Alberta, Canada
| | - Alex Tran
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Kyle Nash
- Department of Psychology, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
10
|
Improving Compliance and Quality of Documentation of Cerebral Function Monitoring in a Neonatal Neurocritical Care Unit. Pediatr Qual Saf 2021; 6:e461. [PMID: 34476313 PMCID: PMC8389948 DOI: 10.1097/pq9.0000000000000461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/27/2021] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is available in the text. Introduction: Neonates admitted to neurocritical care units frequently undergo continuous bedside cerebral function monitoring (CFM). Documentation of CFM findings that are complete and accurate can augment the quality of care through improved communication. We aimed to increase the compliance with and quality of CFM documentation in the electronic medical records by 50% in our neonatal intensive care unit over 6 months. Methods: We used the Plan-Do-Study-Act methodology, process mapping, and fishbone analysis. We implemented interventions, including the development of standardized EMR templates, face-to-face reminders at staff meetings and clinical handover sessions, and teaching on CFM interpretation. Results: We evaluated 50 and 161 charts pre (August–October 2018) and postintervention (December 2018–July 2019), respectively. We improved compliance with documentation from 72% to 89% (P = 0.004); and the quality of documentation from 10% to 61% (P < 0.001). Multimodal reminders to document and educational sessions to increase familiarity with CFM interpretation effectively improved the quality of documentation. Conclusions: We improved the compliance with and the quality of CFM documentation using targeted quality improvement interventions with case-focused educational sessions, reference tools, and standardized templates. Barriers to compliance with documentation were adverse effects on the workflow that changes in the EMR system may address. A significant challenge to sustainability was the high frequency of rotating trainees. We addressed this challenge by developing mandatory electronic teaching modules that include reminders to document and a case-focused teaching curriculum; to increase awareness of the importance of CFM documentation and increase confidence in CFM interpretation.
Collapse
|
11
|
Frohlich J, Toker D, Monti MM. Consciousness among delta waves: a paradox? Brain 2021; 144:2257-2277. [PMID: 33693596 DOI: 10.1093/brain/awab095] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 02/12/2021] [Accepted: 02/25/2021] [Indexed: 01/29/2023] Open
Abstract
A common observation in EEG research is that consciousness vanishes with the appearance of delta (1 - 4 Hz) waves, particularly when those waves are high amplitude. High amplitude delta oscillations are very frequently observed in states of diminished consciousness, including slow wave sleep, anaesthesia, generalised epileptic seizures, and disorders of consciousness such as coma and vegetative state. This strong correlation between loss of consciousness and high amplitude delta oscillations is thought to stem from the widespread cortical deactivation that occurs during the "down states" or troughs of these slow oscillations. Recently, however, many studies have reported the presence of prominent delta activity during conscious states, which casts doubt on the hypothesis that high amplitude delta oscillations are an indicator of unconsciousness. These studies include work in Angelman syndrome, epilepsy, behavioural responsiveness during propofol anaesthesia, postoperative delirium, and states of dissociation from the environment such as dreaming and powerful psychedelic states. The foregoing studies complement an older, yet largely unacknowledged, body of literature that has documented awake, conscious patients with high amplitude delta oscillations in clinical reports from Rett syndrome, Lennox-Gastaut syndrome, schizophrenia, mitochondrial diseases, hepatic encephalopathy, and nonconvulsive status epilepticus. At the same time, a largely parallel body of recent work has reported convincing evidence that the complexity or entropy of EEG and magnetoencephalogram or MEG signals strongly relates to an individual's level of consciousness. Having reviewed this literature, we discuss plausible mechanisms that would resolve the seeming contradiction between high amplitude delta oscillations and consciousness. We also consider implications concerning theories of consciousness, such as integrated information theory and the entropic brain hypothesis. Finally, we conclude that false inferences of unconscious states can be best avoided by examining measures of electrophysiological complexity in addition to spectral power.
Collapse
Affiliation(s)
- Joel Frohlich
- Department of Psychology, University of California Los Angeles, 3423 Franz Hall, Los Angeles, California 90095, USA
| | - Daniel Toker
- Department of Psychology, University of California Los Angeles, 3423 Franz Hall, Los Angeles, California 90095, USA
| | - Martin M Monti
- Department of Psychology, University of California Los Angeles, 3423 Franz Hall, Los Angeles, California 90095, USA.,Department of Neurosurgery, UCLA Brain Injury Research Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California 90095, USA
| |
Collapse
|
12
|
Liu B, Zhang X, Wang L, Li Y, Hou J, Duan G, Guo T, Wu D. Outcome Prediction in Unresponsive Wakefulness Syndrome and Minimally Conscious State by Non-linear Dynamic Analysis of the EEG. Front Neurol 2021; 12:510424. [PMID: 33692735 PMCID: PMC7937604 DOI: 10.3389/fneur.2021.510424] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 02/01/2021] [Indexed: 12/12/2022] Open
Abstract
Objectives: This study aimed to investigate the role of non-linear dynamic analysis (NDA) of the electroencephalogram (EEG) in predicting patient outcome in unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS). Methods: This was a prospective longitudinal cohort study. A total of 98 and 64 UWS and MCS cases, respectively, were assessed. During admission, EEGs were acquired under eyes-closed and pain stimulation conditions. EEG nonlinear indices, including approximate entropy (ApEn) and cross-ApEn, were calculated. The modified Glasgow Outcome Scale (mGOS) was employed to assess functional prognosis 1 year following brain injury. Results: The mGOS scores were improved in 25 (26%) patients with UWS and 42 (66%) with MCS. Under the painful stimulation condition, both non-linear indices were lower in patients with UWS than in those with MCS. The frontal region, periphery of the primary sensory area (S1), and forebrain structure might be the key points modulating disorders of consciousness. The affected local cortical networks connected to S1 and unaffected distant cortical networks connecting S1 to the prefrontal area played important roles in mGOS score improvement. Conclusions: NDA provides an objective assessment of cortical excitability and interconnections of residual cortical functional islands. The impaired interconnection of the residual cortical functional island meant a poorer prognosis. The activation in the affected periphery of the S1 and the increase in the interconnection of affected local cortical areas around the S1 and unaffected S1 to the prefrontal and temporal areas meant a relatively favorable prognosis.
Collapse
Affiliation(s)
- Baohu Liu
- Department of Rehabilitation, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xu Zhang
- Department of Rehabilitation, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Lijia Wang
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada
| | - Yuanyuan Li
- Department of Rehabilitation, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jun Hou
- Department of Rehabilitation, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Guoping Duan
- Department of Rehabilitation, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Tongtong Guo
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Dongyu Wu
- Department of Rehabilitation, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| |
Collapse
|
13
|
García PS, Kreuzer M, Hight D, Sleigh JW. Effects of noxious stimulation on the electroencephalogram during general anaesthesia: a narrative review and approach to analgesic titration. Br J Anaesth 2021; 126:445-457. [PMID: 33461725 DOI: 10.1016/j.bja.2020.10.036] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 10/01/2020] [Accepted: 10/24/2020] [Indexed: 01/10/2023] Open
Abstract
Electroencephalographic (EEG) activity is used to monitor the neurophysiology of the brain, which is a target organ of general anaesthesia. Besides its use in evaluating hypnotic states, neurophysiologic reactions to noxious stimulation can also be observed in the EEG. Recognising and understanding these responses could help optimise intraoperative analgesic management. This review describes three types of changes in the EEG induced by noxious stimulation when the patient is under general anaesthesia: (1) beta arousal, (2) (paradoxical) delta arousal, and (3) alpha dropout. Beta arousal is an increase in EEG power in the beta-frequency band (12-25 Hz) in response to noxious stimulation, especially at lower doses of anaesthesia drugs in the absence of opioids. It is usually indicative of a cortical depolarisation and increased cortical activity. At higher concentrations of anaesthetic drug, and with insufficient opioids, delta arousal (increased power in the delta band [0.5-4 Hz]) and alpha dropout (decreased alpha power [8-12 Hz]) are associated with noxious stimuli. The mechanisms of delta arousal are not well understood, but the midbrain reticular formation seems to play a role. Alpha dropout may indicate a return of thalamocortical communication, from an idling mode to an operational mode. Each of these EEG changes reflect an incomplete modulation of pain signals and can be mitigated by administration of opioid or the use of regional anaesthesia techniques. Future studies should evaluate whether titrating analgesic drugs in response to these EEG signals reduces postoperative pain and influences other postoperative outcomes, including the potential development of chronic pain.
Collapse
Affiliation(s)
- Paul S García
- Department of Anesthesiology, Columbia University, New York, NY, USA.
| | - Matthias Kreuzer
- Department of Anesthesiology and Intensive Care, Technical University of Munich School of Medicine, Munich, Germany
| | - Darren Hight
- Department of Anaesthesiology, Waikato Clinical School, University of Auckland, Hamilton, New Zealand; Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - James W Sleigh
- Department of Anaesthesiology, Waikato Clinical School, University of Auckland, Hamilton, New Zealand
| |
Collapse
|
14
|
Carton-Leclercq A, Lecas S, Chavez M, Charpier S, Mahon S. Neuronal excitability and sensory responsiveness in the thalamo-cortical network in a novel rat model of isoelectric brain state. J Physiol 2020; 599:609-629. [PMID: 33095909 DOI: 10.1113/jp280266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 10/21/2020] [Indexed: 01/04/2023] Open
Abstract
KEY POINTS The neuronal and network properties that persist during an isoelectric coma remain largely unknown. We developed a new in vivo rat model to assess cell excitability and sensory responsiveness in the thalamo-cortical pathway during an isoflurane-induced isoelectric brain state. The isoelectric electrocorticogram reflected a complete interruption of spontaneous synaptic and firing activities in cortical and thalamic neurons. Cell excitability and sensory responses in the thalamo-cortical network persisted at a reduced level in the isoelectric condition and returned to control values after resumption of background brain activity. These findings could lead to a reassessment of the functional status of the drug-induced isoelectric state: a latent state in which individual neurons and networks retain to some extent the ability of being activated by external inputs. ABSTRACT The neuronal and network properties that persist in an isoelectric brain completely deprived of spontaneous electrical activity remain largely unexplored. Here, we developed a new in vivo rat model to examine cell excitability and sensory responsiveness in somatosensory thalamo-cortical networks during the interruption of endogenous brain activity induced by high doses of isoflurane. Electrocorticograms (ECoGs) from the barrel cortex were captured simultaneously with either intracellular recordings of subjacent cortical pyramidal neurons or extracellular records of the related thalamo-cortical neurons. Isoelectric ECoG periods reflected the disappearance of spontaneous synaptic and firing activities in cortical and thalamic neurons. This was associated with a sustained membrane hyperpolarization and a reduced intrinsic excitability in deep-layer cortical neurons, without significant changes in their membrane input resistance. Concomitantly, we found that whisker-evoked potentials in the ECoG and synaptic responses in cortical neurons were attenuated in amplitude and increased in latency. Impaired responsiveness in the barrel cortex paralleled with a lowering of the sensory-induced firing in thalamic cells. The return of endogenous brain electrical activities, after reinstatement of a control isoflurane concentration, led to the recovery of cortical neurons excitability and sensory responsiveness. These findings demonstrate the persistence of a certain level of cell excitability and sensory integration in the isoelectric state and the full recovery of cortico-thalamic functions after restoration of internal cerebral activities.
Collapse
Affiliation(s)
- Antoine Carton-Leclercq
- Institut du Cerveau, ICM, INSERM UMRS 1127, CNRS UMR 7225, Pitié-Salpêtrière Hospital, Paris, France
| | - Sarah Lecas
- Institut du Cerveau, ICM, INSERM UMRS 1127, CNRS UMR 7225, Pitié-Salpêtrière Hospital, Paris, France.,Sorbonne University, UPMC Université Paris, Paris, France
| | - Mario Chavez
- Institut du Cerveau, ICM, INSERM UMRS 1127, CNRS UMR 7225, Pitié-Salpêtrière Hospital, Paris, France
| | - Stéphane Charpier
- Institut du Cerveau, ICM, INSERM UMRS 1127, CNRS UMR 7225, Pitié-Salpêtrière Hospital, Paris, France.,Sorbonne University, UPMC Université Paris, Paris, France
| | - Séverine Mahon
- Institut du Cerveau, ICM, INSERM UMRS 1127, CNRS UMR 7225, Pitié-Salpêtrière Hospital, Paris, France
| |
Collapse
|
15
|
Portnova G, Girzhova I, Filatova D, Podlepich V, Tetereva A, Martynova O. Brain Oscillatory Activity during Tactile Stimulation Correlates with Cortical Thickness of Intact Areas and Predicts Outcome in Post-Traumatic Comatose Patients. Brain Sci 2020; 10:brainsci10100720. [PMID: 33053681 PMCID: PMC7601666 DOI: 10.3390/brainsci10100720] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/23/2020] [Accepted: 10/07/2020] [Indexed: 11/24/2022] Open
Abstract
In this study, we have reported a correlation between structural brain changes and electroencephalography (EEG) in response to tactile stimulation in ten comatose patients after severe traumatic brain injury (TBI). Structural morphometry showed a decrease in whole-brain cortical thickness, cortical gray matter volume, and subcortical structures in ten comatose patients compared to fifteen healthy controls. The observed decrease in gray matter volume indicated brain atrophy in coma patients induced by TBI. In resting-state EEG, the power of slow-wave activity was significantly higher (2–6 Hz), and the power of alpha and beta rhythms was lower in coma patients than in controls. During tactile stimulation, coma patients’ theta rhythm power significantly decreased compared to that in the resting state. This decrease was not observed in the control group and correlated positively with better coma outcome and the volume of whole-brain gray matter, the right putamen, and the insula. It correlated negatively with the volume of damaged brain tissue. During tactile stimulation, an increase in beta rhythm power correlated with the thickness of patients’ somatosensory cortex. Our results showed that slow-wave desynchronization, as a nonspecific response to tactile stimulation, may serve as a sensitive index of coma outcome and morphometric changes after brain injury.
Collapse
Affiliation(s)
- Galina Portnova
- Human High Nervous Activity Laboratory, Institute of Higher Nervous Activity and Neurophysiology of the Russian Academy of Science, 5A Butlerova str., 117485 Moscow, Russia; (A.T.); (O.M.)
- Correspondence: ; Tel.: +7-9031256186
| | - Irina Girzhova
- Faculty of Medicine, Lomonosov Moscow State University, 27 Lomonosovsky pr-t., 119991 Moscow, Russia; (I.G.); (D.F.)
| | - Daria Filatova
- Faculty of Medicine, Lomonosov Moscow State University, 27 Lomonosovsky pr-t., 119991 Moscow, Russia; (I.G.); (D.F.)
| | - Vitaliy Podlepich
- Federal State Autonomous Institution N. N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, 16 4-ya Tverskaya-Yamskaya str., 125047 Moscow, Russia;
| | - Alina Tetereva
- Human High Nervous Activity Laboratory, Institute of Higher Nervous Activity and Neurophysiology of the Russian Academy of Science, 5A Butlerova str., 117485 Moscow, Russia; (A.T.); (O.M.)
| | - Olga Martynova
- Human High Nervous Activity Laboratory, Institute of Higher Nervous Activity and Neurophysiology of the Russian Academy of Science, 5A Butlerova str., 117485 Moscow, Russia; (A.T.); (O.M.)
| |
Collapse
|
16
|
Raucci U, Pro S, Di Capua M, Di Nardo G, Villa MP, Striano P, Parisi P. A reappraisal of the value of video-EEG recording in the emergency department. Expert Rev Neurother 2020; 20:459-475. [PMID: 32249626 DOI: 10.1080/14737175.2020.1747435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Stefano Pro
- Neurophysiological Unit, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Matteo Di Capua
- Neurophysiological Unit, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Giovanni Di Nardo
- Chair of Pediatrics, Child Neurology, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, c/o Sant’Andrea Hospital, Rome, Italy
| | - Maria Pia Villa
- Chair of Pediatrics, Child Neurology, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, c/o Sant’Andrea Hospital, Rome, Italy
| | - Pasquale Striano
- Paediatric Neurology and Muscular Diseases Unit, IRCCS ‘G. Gaslini’ Institute, Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, ‘G. Gaslini’ Institute, Genova, Italy
| | - Pasquale Parisi
- Chair of Pediatrics, Child Neurology, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, c/o Sant’Andrea Hospital, Rome, Italy
| |
Collapse
|
17
|
Emidio AC, Faria R, Patricio P, Canas N, Messias A, Meneses-Oliveira C. Spindle Coma in the Intensive Care Unit: Different Aetiologies - Different Outcomes. Eur J Case Rep Intern Med 2020; 6:001316. [PMID: 31890714 PMCID: PMC6886626 DOI: 10.12890/2019_001316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 10/15/2019] [Indexed: 11/17/2022] Open
Abstract
Spindle coma is an electroclinical entity that has been used to describe an EEG pattern of “sleep-like” activity in comatose patients. Although it has been associated with favourable prognosis, its aetiology is one of the key factors for patient outcome. The authors present three cases of spindle coma with different aetiologies (amitriptyline overdose, pontine myelinolysis and hypoxic-ischaemic encephalopathy) that culminated in different outcomes.
Collapse
Affiliation(s)
- Ana Catarina Emidio
- Internal Medicine Department, Hospital de São Bernardo, Centro Hospitalar de Setúbal, Portugal
| | - Rita Faria
- Intensive Medicine Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Patricia Patricio
- Intensive Medicine Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Nuno Canas
- Neurophysiology laboratory, Neurology Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - António Messias
- Intensive Medicine Department, Hospital Beatriz Ângelo, Loures, Portugal
| | | |
Collapse
|
18
|
Sewell L, Abbas A, Kane N. Introduction to interpretation of the EEG in intensive care. BJA Educ 2019; 19:74-82. [PMID: 33456874 DOI: 10.1016/j.bjae.2018.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2018] [Indexed: 01/10/2023] Open
Affiliation(s)
- L Sewell
- North Bristol NHS Trust, Bristol, UK
| | - A Abbas
- Queen Elizabeth Hospital, Birmingham, UK
| | - N Kane
- North Bristol NHS Trust, Bristol, UK
| |
Collapse
|
19
|
Straudi S, Bonsangue V, Mele S, Craighero L, Montis A, Fregni F, Lavezzi S, Basaglia N. Bilateral M1 anodal transcranial direct current stimulation in post traumatic chronic minimally conscious state: a pilot EEG-tDCS study. Brain Inj 2019; 33:490-495. [PMID: 30632807 DOI: 10.1080/02699052.2019.1565894] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE We tested the preliminary effects of bilateral anodal transcranial direct current stimulation (tDCS) in patients with disorders of consciousness. DESIGN Open label pilot study. SUBJECTS Ten chronic (greater than 12 months) patients in a minimally conscious state (MCS) following severe traumatic brain injury. METHODS The patients received 10 sessions of bilateral M1 anodal tDCS. Behavioural changes were assessed with the Coma Recovery Scale-Revised (CRS-R) before stimulation (T-1, T0), after five sessions (T1), at the end of the stimulation (T2), after two weeks (T3) and after three months (T4). Moreover, an EEG assessment was conducted. RESULTS Eight out of 10 patients showed new clinical signs of consciousness; specifically, a 2-point CRS-R improvement was detected in the last follow-up (p = 0.004). EEG upper α bandwidth was greater in the parietal site at T1 (p < 0.034). In addition, we found a significant correlation between behavioral and EEG indices at T1 (r = 0.89; p = 0.001). CONCLUSION This preliminary study presents several limitations (small sample size and no control group). However, it provides important initial data that can be used to design randomized clinical trials testing this novel approach in MCS and to further explore EEG as a neural marker for the effects of tDCS.
Collapse
Affiliation(s)
- Sofia Straudi
- a Neuroscience and Rehabilitation Department , Ferrara University Hospital , Ferrara , Italy
| | - Valentina Bonsangue
- a Neuroscience and Rehabilitation Department , Ferrara University Hospital , Ferrara , Italy
| | - Sonia Mele
- b Biomedical and Specialty Surgical Sciences Department , Ferrara University , Ferrara , Italy
| | - Laila Craighero
- b Biomedical and Specialty Surgical Sciences Department , Ferrara University , Ferrara , Italy
| | - Andrea Montis
- c Sardinian Health Trust , Neurorehabilitation Unit, San Martino Hospital , Oristano , Italy
| | - Felipe Fregni
- d Department of Physical Medicine and Rehabilitation, Harvard Medical School , Neuromodulation Center, Spaulding Rehabilitation Hospital , Boston , MA , USA
| | - Susanna Lavezzi
- a Neuroscience and Rehabilitation Department , Ferrara University Hospital , Ferrara , Italy
| | - Nino Basaglia
- a Neuroscience and Rehabilitation Department , Ferrara University Hospital , Ferrara , Italy
| |
Collapse
|
20
|
Clinical neurophysiology of altered states of consciousness: Encephalopathy and coma. HANDBOOK OF CLINICAL NEUROLOGY 2019; 161:73-88. [PMID: 31307621 DOI: 10.1016/b978-0-444-64142-7.00041-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The neurophysiologist will commonly encounter patients with encephalopathy/delirium (altered consciousness with impaired cognition, usually with sleep-wake cycle alteration and lethargy) or coma (an eyes-closed state of unresponsiveness) in the hospital setting. Assessing the background frequency of the EEG, as well as the presence or absence of other features (reactivity, periodic discharges such as triphasic waves), can provide insight into the patient's underlying condition and in some cases may provide prognostic information. The literature of postanoxic arrest EEG patterns continues to expand. Other neurophysiologic tests, such as somatosensory evoked potentials, auditory mismatch negativity, and even EMG, may also play a role in assessing brain function; distinguishing among a locked-in state, minimally conscious state, persistent vegetative state, and waking/unresponsive states; and assessing the potential for recovery after brain injury.
Collapse
|
21
|
Li F, Liu G, Tian X, Quan F, Li B, Feng G, Wang X, Hu Y. A novel scoring system to predict the outcomes of adult patients with hypoxic-ischemic encephalopathy. Expert Rev Neurother 2018; 18:343-350. [PMID: 29495903 DOI: 10.1080/14737175.2018.1447925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Adult patients with hypoxic-ischemic encephalopathy (HIE) often incur large costs, but their outcomes are poor. Currently, there is lack of a comprehensive quantitative approach to predict patient prognoses. METHODS A total of 73 adult patients with HIE participated in this prospective, observational study. Clinical assessments, laboratory tests, and electrophysiological examinations were conducted within 3 days after HIE occurred. Logistic regression model was used to identify independent factors associated with patient outcomes. RESULTS After a 6-month follow-up, 44 (61.1%) patients survived, 28 (38.9%) patients died, and one patient was lost to follow-up. The level of blood calcium and lactate, the presence of electroencephalography reactivity, and Glasgow Coma Scale (GCS) score were significantly associated with the patient's outcome. Based on the regression coefficients from logistic regression analysis, we constructed a scoring system (CEGL; C: calcium, E: EEG reactivity, G: GCS, L: lactate) to predict the possibility of a patient's death. The area under the receiver operating characteristic curve was 0.91 (P < 0.001, 95% CI [0.87-0.95]) with a specificity of 97.7% and a positive predictive value of 97.4%. CONCLUSION CEGL score can provide clinicians useful information for assessment of patient prognosis within 6 months after HIE.
Collapse
Affiliation(s)
- Feng Li
- a Department of Neurology , The First Affiliated Hospital of Chongqing Medical University , Chongqing , People's Republic of China
| | - Guangwei Liu
- a Department of Neurology , The First Affiliated Hospital of Chongqing Medical University , Chongqing , People's Republic of China
| | - Xin Tian
- a Department of Neurology , The First Affiliated Hospital of Chongqing Medical University , Chongqing , People's Republic of China
| | - Fengying Quan
- a Department of Neurology , The First Affiliated Hospital of Chongqing Medical University , Chongqing , People's Republic of China
| | - Bosong Li
- b Department of communicable disease control , Center for Disease Control and Prevention , Chongqing , People's Republic of China
| | - Guibo Feng
- c Department of Neurology , Yongchuan Hospital of Chongqing Medical University , Chongqing , People's Republic of China
| | - Xuefeng Wang
- a Department of Neurology , The First Affiliated Hospital of Chongqing Medical University , Chongqing , People's Republic of China
| | - Yida Hu
- a Department of Neurology , The First Affiliated Hospital of Chongqing Medical University , Chongqing , People's Republic of China
| |
Collapse
|
22
|
Altwegg-Boussac T, Schramm AE, Ballestero J, Grosselin F, Chavez M, Lecas S, Baulac M, Naccache L, Demeret S, Navarro V, Mahon S, Charpier S. Cortical neurons and networks are dormant but fully responsive during isoelectric brain state. Brain 2017; 140:2381-2398. [PMID: 29050394 DOI: 10.1093/brain/awx175] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 05/29/2017] [Indexed: 01/30/2023] Open
Abstract
A continuous isoelectric electroencephalogram reflects an interruption of endogenously-generated activity in cortical networks and systematically results in a complete dissolution of conscious processes. This electro-cerebral inactivity occurs during various brain disorders, including hypothermia, drug intoxication, long-lasting anoxia and brain trauma. It can also be induced in a therapeutic context, following the administration of high doses of barbiturate-derived compounds, to interrupt a hyper-refractory status epilepticus. Although altered sensory responses can be occasionally observed on an isoelectric electroencephalogram, the electrical membrane properties and synaptic responses of individual neurons during this cerebral state remain largely unknown. The aim of the present study was to characterize the intracellular correlates of a barbiturate-induced isoelectric electroencephalogram and to analyse the sensory-evoked synaptic responses that can emerge from a brain deprived of spontaneous electrical activity. We first examined the sensory responsiveness from patients suffering from intractable status epilepticus and treated by administration of thiopental. Multimodal sensory responses could be evoked on the flat electroencephalogram, including visually-evoked potentials that were significantly amplified and delayed, with a high trial-to-trial reproducibility compared to awake healthy subjects. Using an analogous pharmacological procedure to induce prolonged electro-cerebral inactivity in the rat, we could describe its cortical and subcortical intracellular counterparts. Neocortical, hippocampal and thalamo-cortical neurons were all silent during the isoelectric state and displayed a flat membrane potential significantly hyperpolarized compared with spontaneously active control states. Nonetheless, all recorded neurons could fire action potentials in response to intracellularly injected depolarizing current pulses and their specific intrinsic electrophysiological features were preserved. Manipulations of the membrane potential and intracellular injection of chloride in neocortical neurons failed to reveal an augmented synaptic inhibition during the isoelectric condition. Consistent with the sensory responses recorded from comatose patients, large and highly reproducible somatosensory-evoked potentials could be generated on the inactive electrocorticogram in rats. Intracellular recordings revealed that the underlying neocortical pyramidal cells responded to sensory stimuli by complex synaptic potentials able to trigger action potentials. As in patients, sensory responses in the isoelectric state were delayed compared to control responses and exhibited an elevated reliability during repeated stimuli. Our findings demonstrate that during prolonged isoelectric brain state neurons and synaptic networks are dormant rather than excessively inhibited, conserving their intrinsic properties and their ability to integrate and propagate environmental stimuli.
Collapse
Affiliation(s)
- Tristan Altwegg-Boussac
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, F-75013, Paris, France
| | - Adrien E Schramm
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, F-75013, Paris, France
| | - Jimena Ballestero
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, F-75013, Paris, France
| | - Fanny Grosselin
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, F-75013, Paris, France
| | - Mario Chavez
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, F-75013, Paris, France
| | - Sarah Lecas
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, F-75013, Paris, France.,UPMC Univ Paris 06, F-75005, Paris, France
| | - Michel Baulac
- Epilepsy Unit, Clinical Neurophysiology Department, AP-HP, Hôpital Pitié-Salpêtrière, F-75013, Paris, France
| | - Lionel Naccache
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, F-75013, Paris, France.,Evoked Potential Unit, Neurophysiology Department, AP-HP, Hôpital Pitié-Salpêtrière, F-75013, Paris, France
| | - Sophie Demeret
- Intensive Care Unit of Neurology, Neurology Department, AP-HP, Hôpital Pitié-Salpêtrière, F-75013, Paris, France
| | - Vincent Navarro
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, F-75013, Paris, France.,Epilepsy Unit, Clinical Neurophysiology Department, AP-HP, Hôpital Pitié-Salpêtrière, F-75013, Paris, France
| | - Séverine Mahon
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, F-75013, Paris, France
| | - Stéphane Charpier
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, F-75013, Paris, France.,UPMC Univ Paris 06, F-75005, Paris, France
| |
Collapse
|
23
|
Mehta B, Griffiths N, Spence K, Laing S. Inter-observer reliability in reading amplitude-integrated electroencephalogram in the newborn intensive care unit. J Paediatr Child Health 2017; 53:1007-1012. [PMID: 28589638 DOI: 10.1111/jpc.13589] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 02/16/2017] [Accepted: 04/02/2017] [Indexed: 11/28/2022]
Abstract
AIM Amplitude-integrated electroencephalogram (aEEG) is widely used in neonates to detect electrical seizure and predict outcome following hypoxic ischaemic encephalopathy and other encephalopathy. Because accurate interpretation is important for clinical decision-making and family counselling, inter-observer reliability is a major concern. We aimed to evaluate inter-observer reliability in the interpretation of aEEG tracings in a neonatal intensive care unit. METHODS Three neonatal intensive care unit clinicians with different levels of experience in reading aEEG independently reviewed and scored aEEG traces using standardised criteria, categories and interpretation rules. Inter-observer reliability was evaluated using weighted Cohen's κ and intra-class correlation coefficients. RESULTS All 131 tracings from 120 neonates were reviewed by the neontalogist, 128 (97.7%) by the clinical nurse specialist, 73 (55.7%) by the nurse educator and 70 (53.4%) by all three clinicians. The majority (88 of 120, 73.3%) were term infants (mean gestational age 38 weeks, standard deviation 3.2). Average duration of recording was 27 h (standard deviation 19.1, range 1-105 h). Inter-observer reliability varied across categories and observers - from very good to excellent for the main background activity (intra-class correlation coefficients 0.93-0.98); good to very good for seizures; and moderate to very good for sleep-wake cycle and quality of recording (weighted κs' 0.71-0.85, 0.50-0.75, 0.46-0.81, respectively). CONCLUSION While certain aEEG features appear challenging to inter-observer reliability, our findings suggest that with training and consensus guidelines, levels of reliability needed to enhance clinical and prognostic usefulness of aEEG are achievable across clinicians with different levels of experience in reading aEEG.
Collapse
Affiliation(s)
- Bhavesh Mehta
- Grace Centre for Newborn Care, Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Nadine Griffiths
- Grace Centre for Newborn Care, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Kaye Spence
- Grace Centre for Newborn Care, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Sharon Laing
- School of Social Sciences and Psychology, Western Sydney University, Sydney, New South Wales, Australia
| |
Collapse
|
24
|
Kotchoubey B. Evoked and event-related potentials in disorders of consciousness: A quantitative review. Conscious Cogn 2017; 54:155-167. [DOI: 10.1016/j.concog.2017.05.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 04/18/2017] [Accepted: 05/10/2017] [Indexed: 11/25/2022]
|
25
|
Admiraal MM, van Rootselaar AF, Horn J. Electroencephalographic reactivity testing in unconscious patients: a systematic review of methods and definitions. Eur J Neurol 2016; 24:245-254. [PMID: 27981707 DOI: 10.1111/ene.13219] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 11/07/2016] [Indexed: 11/28/2022]
Abstract
Electroencephalographic (EEG) reactivity testing is often presented as a clear-cut element of electrophysiological testing. Absence of EEG reactivity is generally considered an indicator of poor outcome, especially in patients after cardiac arrest. However, guidelines do not clearly describe how to test for reactivity and how to evaluate the results. In a quest for clear guidelines, we performed a systematic review aimed at identifying testing methods and definitions of EEG reactivity. We systematically searched the literature between 1970 and May 2016. Methodological quality of the studies was assessed using the QUality In Prognostic Studies tool. Quality of the descriptions of stimulus protocol and reactivity definition was rated on a four-category grading scale based on reproducibility. We found that protocols for EEG reactivity testing vary greatly and descriptions of protocols are almost never replicable. Furthermore, replicable definitions of presence or absence of EEG reactivity are never provided. In order to draw firm conclusions on EEG reactivity as a prognostic factor, future studies should include a precise stimulation protocol and reactivity definition to facilitate guideline formation.
Collapse
Affiliation(s)
- M M Admiraal
- Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands
| | - A-F van Rootselaar
- Department of Neurology/Clinical Neurophysiology, Academic Medical Center, Amsterdam, The Netherlands
| | - J Horn
- Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands.,Laboratory for Experimental Intensive Care and Anesthesiology, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
26
|
EEG for Diagnosis and Prognosis of Acute Nonhypoxic Encephalopathy: History and Current Evidence. J Clin Neurophysiol 2016; 32:456-64. [PMID: 26629755 DOI: 10.1097/wnp.0000000000000164] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The term encephalopathy encompasses a wide variety of complex syndromes caused by a large number of different toxic, metabolic, infectious, and degenerative derangements. Acute encephalopathy typically presents with a fluctuating course involving alteration of mental status or confusion and decreased (or rarely increased) motor activity. There usually are lethargy, cognitive impairment, altered memory and mental processing of information, and disturbed sleep-wake cycles. Encephalopathy mainly occurs in the elderly and is frequently encountered in intensive care units and postoperatively. Despite new diagnostic procedures and advances in intensive medical care, acute encephalopathy constitutes a significant cause of morbidity and mortality in hospitalized patients. EEG enables rapid bedside electrophysiological monitoring providing dynamic real-time information on neocortical brain activity and dysfunction. Hence, EEG complements clinical and neuroimaging assessments of encephalopathic patients. Progressive slowing of EEG background activity with increasing cerebral compromise, the emergence of episodic electrographic transients, seizures, and decreased EEG reactivity to external stimuli provide important diagnostic and prognostic information. The aim of this review was to provide a comprehensive overview of the current evidence for the diagnostic and prognostic value of EEG in adult intensive care unit patients with acute nonhypoxic encephalopathy.
Collapse
|
27
|
Bolen RD, Campbell Z, Bonilha L, Edwards JC. Alpha coma related to intentional bupropion overdose. J Neurol Sci 2016; 365:48-9. [DOI: 10.1016/j.jns.2016.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 04/05/2016] [Accepted: 04/06/2016] [Indexed: 10/22/2022]
|
28
|
Pana R, Hornby L, Shemie SD, Dhanani S, Teitelbaum J. Time to loss of brain function and activity during circulatory arrest. J Crit Care 2016; 34:77-83. [PMID: 27288615 DOI: 10.1016/j.jcrc.2016.04.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 04/03/2016] [Accepted: 04/04/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE Brain function during the dying process and around the time of cardiac arrest is poorly understood. To better inform the clinical physiology of the dying process and organ donation practices, we performed a scoping review of the literature to assess time to loss of brain function and activity after circulatory arrest. MATERIALS AND METHODS Medline and Embase databases were searched from inception to June 2014 for articles reporting the time interval to loss of brain function or activity after loss of systemic circulation. RESULTS Thirty-nine studies met selection criteria. Seven human studies and 10 animal studies reported that electroencephalography (EEG) activity is lost less than 30seconds after abrupt circulatory arrest. In the setting of existing brain injury, with progressive loss of oxygenated circulation, loss of EEG may occur before circulatory arrest. Cortical evoked potentials may persist for several minutes after loss of circulation. CONCLUSION The time required to lose brain function varied according to clinical context and method by which this function is measured. Most studies show that clinical loss of consciousness and loss of EEG activity occur within 30seconds after abrupt circulatory arrest and may occur before circulatory arrest after progressive hypoxia-ischemia. Prospective clinical studies are required to confirm these observations.
Collapse
Affiliation(s)
- R Pana
- Division of Neurology, McGill University Health Center, Montreal, QC, Canada.
| | - L Hornby
- Division of Pediatric Critical Care, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada; Deceased Donation, Canadian Blood Services, Ottawa, ON, Canada
| | - S D Shemie
- Deceased Donation, Canadian Blood Services, Ottawa, ON, Canada; Division of Critical Care, Montreal Children's Hospital, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - S Dhanani
- Children's Hospital of Eastern Ontario, Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - J Teitelbaum
- Division of Neurology and Neurosurgery, McGill University Health Center, Montreal Neurological Institute, Montreal, QC, Canada
| |
Collapse
|
29
|
Altwegg-Boussac T, Mahon S, Chavez M, Charpier S, Schramm AE. Induction of an Isoelectric Brain State to Investigate the Impact of Endogenous Synaptic Activity on Neuronal Excitability In Vivo. J Vis Exp 2016:e53576. [PMID: 27078163 PMCID: PMC4841322 DOI: 10.3791/53576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The way neurons process information depends both on their intrinsic membrane properties and on the dynamics of the afferent synaptic network. In particular, endogenously-generated network activity, which strongly varies as a function of the state of vigilance, significantly modulates neuronal computation. To investigate how different spontaneous cerebral dynamics impact single neurons' integrative properties, we developed a new experimental strategy in the rat consisting in suppressing in vivo all cerebral activity by means of a systemic injection of a high dose of sodium pentobarbital. Cortical activities, continuously monitored by combined electrocorticogram (ECoG) and intracellular recordings are progressively slowed down, leading to a steady isoelectric profile. This extreme brain state, putting the rat into a deep comatose, was carefully monitored by measuring the physiological constants of the animal throughout the experiments. Intracellular recordings allowed us to characterize and compare the integrative properties of the same neuron embedded into physiologically relevant cortical dynamics, such as those encountered in the sleep-wake cycle, and when the brain was fully silent.
Collapse
Affiliation(s)
- Tristan Altwegg-Boussac
- Inserm U1127; CNRS UMR 7225; UPMC Univ Paris 06, UMR S 1127, Sorbonne Universités; Institut du Cerveau et de la Moelle épinière (ICM)
| | - Séverine Mahon
- Inserm U1127; CNRS UMR 7225; UPMC Univ Paris 06, UMR S 1127, Sorbonne Universités; Institut du Cerveau et de la Moelle épinière (ICM)
| | - Mario Chavez
- Inserm U1127; CNRS UMR 7225; UPMC Univ Paris 06, UMR S 1127, Sorbonne Universités; Institut du Cerveau et de la Moelle épinière (ICM)
| | - Stéphane Charpier
- Inserm U1127; CNRS UMR 7225; UPMC Univ Paris 06, UMR S 1127, Sorbonne Universités; Institut du Cerveau et de la Moelle épinière (ICM)
| | - Adrien E Schramm
- Inserm U1127; CNRS UMR 7225; UPMC Univ Paris 06, UMR S 1127, Sorbonne Universités; Institut du Cerveau et de la Moelle épinière (ICM);
| |
Collapse
|
30
|
Rodríguez V, Rodden MF, LaRoche SM. Ictal-interictal continuum: A proposed treatment algorithm. Clin Neurophysiol 2016; 127:2056-64. [PMID: 26971489 DOI: 10.1016/j.clinph.2016.02.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 01/18/2016] [Accepted: 02/05/2016] [Indexed: 01/27/2023]
Abstract
The ictal-interictal continuum (IIC) is characterized by periodic and/or rhythmic EEG patterns that occur with relative high frequency in critically ill patients. Several studies have reported that some patterns seen within the continuum are independently associated with poor outcome. However there is no consensus regarding when to treat them or how aggressive treatment should be. In this review we examine peer-reviewed original scientific articles, guidelines and reviews indexed in PubMed and summarize current knowledge related to the ictal-interictal continuum. A treatment algorithm to guide management of critically ill patients with EEG patterns that fall along the IIC is proposed. The algorithm-based on best current practice in adults-takes into account associated clinical events, risk factors for developing seizures, response to medication trials and biomarkers of neuronal injury.
Collapse
Affiliation(s)
- Valia Rodríguez
- Cuban Neuroscience Center & Clinical-Surgical Hospital 'Hnos Ameijeiras', Cuba.
| | | | | |
Collapse
|
31
|
Trinka E, Leitinger M. Which EEG patterns in coma are nonconvulsive status epilepticus? Epilepsy Behav 2015; 49:203-22. [PMID: 26148985 DOI: 10.1016/j.yebeh.2015.05.005] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 05/02/2015] [Indexed: 10/23/2022]
Abstract
Nonconvulsive status epilepticus (NCSE) is common in patients with coma with a prevalence between 5% and 48%. Patients in deep coma may exhibit epileptiform EEG patterns, such as generalized periodic spikes, and there is an ongoing debate about the relationship of these patterns and NCSE. The purposes of this review are (i) to discuss the various EEG patterns found in coma, its fluctuations, and transitions and (ii) to propose modified criteria for NCSE in coma. Classical coma patterns such as diffuse polymorphic delta activity, spindle coma, alpha/theta coma, low output voltage, or burst suppression do not reflect NCSE. Any ictal patterns with a typical spatiotemporal evolution or epileptiform discharges faster than 2.5 Hz in a comatose patient reflect nonconvulsive seizures or NCSE and should be treated. Generalized periodic diacharges or lateralized periodic discharges (GPDs/LPDs) with a frequency of less than 2.5 Hz or rhythmic discharges (RDs) faster than 0.5 Hz are the borderland of NCSE in coma. In these cases, at least one of the additional criteria is needed to diagnose NCSE (a) subtle clinical ictal phenomena, (b) typical spatiotemporal evolution, or (c) response to antiepileptic drug treatment. There is currently no consensus about how long these patterns must be present to qualify for NCSE, and the distinction from nonconvulsive seizures in patients with critical illness or in comatose patients seems arbitrary. The Salzburg Consensus Criteria for NCSE [1] have been modified according to the Standardized Terminology of the American Clinical Neurophysiology Society [2] and validated in three different cohorts, with a sensitivity of 97.2%, a specificity of 95.9%, and a diagnostic accuracy of 96.3% in patients with clinical signs of NCSE. Their diagnostic utility in different cohorts with patients in deep coma has to be studied in the future. This article is part of a Special Issue entitled "Status Epilepticus".
Collapse
Affiliation(s)
- Eugen Trinka
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Centre for Cognitive Neuroscience, Salzburg, Austria.
| | - Markus Leitinger
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
| |
Collapse
|
32
|
Abend NS, Mani R, Tschuda TN, Chang T, Topjian AA, Donnelly M, LaFalce D, Krauss MC, Schmitt SE, Levine JM. EEG Monitoring during Therapeutic Hypothermia in Neonates, Children, and Adults. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/1086508x.2011.11079816] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Nicholas S. Abend
- Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Ram Mani
- Penn Epilepsy Center, Department of Neurology Hospital of the University of Pennsylvania University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Tammy N. Tschuda
- Departments of Neurology, Children's National Medical Center, Washington, DC
| | - Tae Chang
- Departments of Neurology, Children's National Medical Center, Washington, DC
| | - Alexis A. Topjian
- Department of Anesthesia and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Maureen Donnelly
- Neurodiagnostic Laboratory, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Denise LaFalce
- Neurodiagnostic Laboratory, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Margaret C. Krauss
- Neurodiagnostic Laboratory, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Sarah E. Schmitt
- Penn Epilepsy Center, Department of Neurology Hospital of the University of Pennsylvania University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Joshua M. Levine
- Division of Neurocritical Care, Departments of Neurology, Neurosurgery, and Anesthesiology and Critical Care, Hospital of the University of Pennsylvania University of Pennsylvania School of Medicine Philadelphia, Pennsylvania
| |
Collapse
|
33
|
Affiliation(s)
- Francesco Brigo
- Department of Neurological, Neuropsychological, Morphological and Movement Sciences Section of Neurology University of Verona Verona, Italy
| | - Monica Storti
- Department of Medicine Section of Gastroenterology University of Verona Verona, Italy
| |
Collapse
|
34
|
Kartal A, Kurt ANÇ, Gürkaş E, Aydin K, Serdaroğlu A. Subacute sclerosing panencephalitis presenting as schizophrenia with an alpha coma pattern in a child. J Child Neurol 2014; 29:NP111-3. [PMID: 24141274 DOI: 10.1177/0883073813507484] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Subacute sclerosing panencephalitis, a progressive neurodegenerative disorder of the central nervous system, can present atypically with uncharacteristic electroencephalographic (EEG) features at its onset albeit typically with progressive mental deterioration, behavioral changes, and myoclonic jerks. An atypical presentation of subacute sclerosing panencephalitis can lead to a delay in diagnosis, thus hindering early treatment. Herein, we describe a 14-year-old girl who presented with insomnia, amnesia, auditory and visual hallucinations. The patient's electroencephalography on admission showed an alpha coma pattern. In spite of antipsychiatric treatment (olanzapine 20 mg/d) for 3 months, a progressive deterioration in neurologic function was observed. Subacute sclerosing panencephalitis was suspected and diagnosis was confirmed by increased titers of measles antibodies in the cerebrospinal fluid. The attention of pediatricians should be drawn to psychiatric symptoms as possible initial presentations of subacute sclerosing panencephalitis in order to avoid needless diagnostic and treatment procedures.
Collapse
Affiliation(s)
- Ayşe Kartal
- Department of Child Neurology, Inonu University Faculty of Medicine Malatya, Turkey
| | | | - Esra Gürkaş
- Department of Child Neurology, Gazi University Facult of Medicine Ankara, Turkey
| | - Kurşad Aydin
- Department of Child Neurology, Gazi University Facult of Medicine Ankara, Turkey
| | - Ayşe Serdaroğlu
- Department of Child Neurology, Gazi University Facult of Medicine Ankara, Turkey
| |
Collapse
|
35
|
Falsaperla R, Striano P, Parisi P, Lubrano R, Mahmood F, Pavone P, Vitaliti G. Usefulness of video-EEG in the paediatric emergency department. Expert Rev Neurother 2014; 14:769-785. [PMID: 24917085 DOI: 10.1586/14737175.2014.923757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Over the past two decades the EEG has technically improved from the use of analog to digital machines and more recently to video-EEG systems. Despite these advances, recording a technically acceptable EEG in an electrically hostile environment such as the emergency department (ED) remains a challenge, particularly with infants or young children. In 1996, a meeting of French experts established a set of guidelines for performing an EEG in the ED based on a review of the available literature. The authors highlighted the most suitable indications for an emergency EEG including clinical suspicion of cerebral death, convulsive and myoclonic status epilepticus, focal or generalized relapsing convulsive seizures as well as follow-up of known convulsive patients. They further recommended emergency EEG in the presence of doubt regarding the epileptic nature of the presentation as well as during the initiation or modification of sedation following brain injury. Subsequently, proposals for expanding the use of EEG in emergency patients have been advocated including trauma, vascular and anoxic-ischemic injury due to cardiorespiratory arrest, postinfective encephalopathy and nonconvulsive status epilepticus. The aim of this review is to show the diagnostic importance of video-EEG, as well as highlighting the predictive prognostic factors for positive and negative outcomes, when utilized in the pediatric ED for seizures as well as other neurological presentations.
Collapse
Affiliation(s)
- Raffaele Falsaperla
- Pediatric Acute and Emergency Operative Unit and Department, Policlinico-Vittorio Emanuele University Hospital, University of Catania, Via Plebiscito 628, 95124 Catania, Italy
| | | | | | | | | | | | | |
Collapse
|
36
|
Willingham M, Ben Abdallah A, Gradwohl S, Helsten D, Lin N, Villafranca A, Jacobsohn E, Avidan M, Kaiser H. Association between intraoperative electroencephalographic suppression and postoperative mortality. Br J Anaesth 2014; 113:1001-8. [PMID: 24852500 DOI: 10.1093/bja/aeu105] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Low bispectral index values frequently reflect EEG suppression and have been associated with postoperative mortality. This study investigated whether intraoperative EEG suppression was an independent predictor of 90 day postoperative mortality and explored risk factors for EEG suppression. METHODS This observational study included 2662 adults enrolled in the B-Unaware or BAG-RECALL trials. A cohort was defined with >5 cumulative minutes of EEG suppression, and 1:2 propensity-matched to a non-suppressed cohort (≤5 min suppression). We evaluated the association between EEG suppression and mortality using multivariable logistic regression, and examined risk factors for EEG suppression using zero-inflated mixed effects analysis. RESULTS Ninety day postoperative mortality was 3.9% overall, 6.3% in the suppressed cohort, and 3.0% in the non-suppressed cohort {odds ratio (OR) [95% confidence interval (CI)]=2.19 (1.48-3.26)}. After matching and multivariable adjustment, EEG suppression was not associated with mortality [OR (95% CI)=0.83 (0.55-1.25)]; however, the interaction between EEG suppression and mean arterial pressure (MAP) <55 mm Hg was [OR (95% CI)=2.96 (1.34-6.52)]. Risk factors for EEG suppression were older age, number of comorbidities, chronic obstructive pulmonary disease, and higher intraoperative doses of benzodiazepines, opioids, or volatile anaesthetics. EEG suppression was less likely in patients with cancer, preoperative alcohol, opioid or benzodiazepine consumption, and intraoperative nitrous oxide exposure. CONCLUSIONS Although EEG suppression was associated with increasing anaesthetic administration and comorbidities, the hypothesis that intraoperative EEG suppression is a predictor of postoperative mortality was only supported if it was coincident with low MAP. CLINICAL TRIAL REGISTRATION NCT00281489 and NCT00682825.
Collapse
Affiliation(s)
- M Willingham
- Department of Anesthesiology, Washington University in St Louis School of Medicine, Campus Box 8054, 660 S. Euclid Ave., St Louis, MO 63110, USA
| | - A Ben Abdallah
- Department of Anesthesiology, Washington University in St Louis School of Medicine, Campus Box 8054, 660 S. Euclid Ave., St Louis, MO 63110, USA
| | - S Gradwohl
- Department of Anesthesiology, Washington University in St Louis School of Medicine, Campus Box 8054, 660 S. Euclid Ave., St Louis, MO 63110, USA
| | - D Helsten
- Department of Anesthesiology, Washington University in St Louis School of Medicine, Campus Box 8054, 660 S. Euclid Ave., St Louis, MO 63110, USA
| | - N Lin
- Department of Mathematics, Washington University in St Louis, Campus Box 1146, One Brookings Drive, St Louis, MO 63130, USA
| | - A Villafranca
- Department of Anesthesia and Perioperative Medicine, University of Manitoba, 2nd Floor, Harry Medovy House, 671 William Ave., Winnipeg, Canada MB R3E 0Z2
| | - E Jacobsohn
- Department of Anesthesia and Perioperative Medicine, University of Manitoba, 2nd Floor, Harry Medovy House, 671 William Ave., Winnipeg, Canada MB R3E 0Z2
| | - M Avidan
- Department of Anesthesiology, Washington University in St Louis School of Medicine, Campus Box 8054, 660 S. Euclid Ave., St Louis, MO 63110, USA
| | - H Kaiser
- Department of Anesthesiology, Washington University in St Louis School of Medicine, Campus Box 8054, 660 S. Euclid Ave., St Louis, MO 63110, USA
| |
Collapse
|
37
|
Li Y, Liu XP, Ling XH, Li JQ, Yang WW, Zhang DK, Li LH, Yang Y. Mapping brain injury with symmetrical-channels' EEG signal analysis--a pilot study. Sci Rep 2014; 4:5023. [PMID: 24846704 PMCID: PMC4028679 DOI: 10.1038/srep05023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 05/02/2014] [Indexed: 11/09/2022] Open
Abstract
A technique for detecting brain injury at the bedside has great clinical value, but conventional imaging techniques (such as computed tomography [CT] and magnetic resonance imaging) are impractical. In this study, a novel method–the symmetrical channel electroencephalogram (EEG) signal analysis–was developed for this purpose. The study population consisted of 45 traumatic brain injury patients and 10 healthy controls. EEG signals in resting and stimulus states were acquired, and approximate entropy (ApEn) and slow-wave coefficient were extracted to calculate the ratio values of ApEn and SWC for injured and uninjured areas. Statistical analyses showed that the ratio values for both ApEn and SWC between injured and uninjured brain areas differed significantly (P < 0.05) for both resting and name call stimulus states. A set of criteria (range of ratio values) to determine whether a brain area is injured or uninjured was proposed and its reliability was verified by statistical analyses and CT images.
Collapse
Affiliation(s)
- Yi Li
- 1] College of Life Information Science & Instrument Engineering, Hangzhou Dianzi University, Hangzhou Zhejiang 310018, China [2]
| | - Xiao-ping Liu
- 1] College of Life Information Science & Instrument Engineering, Hangzhou Dianzi University, Hangzhou Zhejiang 310018, China [2]
| | - Xian-hong Ling
- College of Life Information Science & Instrument Engineering, Hangzhou Dianzi University, Hangzhou Zhejiang 310018, China
| | - Jing-qi Li
- Wu jing Hospital, Rehabilitation Center, Hangzhou Zhejiang 31400, China
| | - Wen-wei Yang
- College of Life Information Science & Instrument Engineering, Hangzhou Dianzi University, Hangzhou Zhejiang 310018, China
| | - Dan-ke Zhang
- College of Life Information Science & Instrument Engineering, Hangzhou Dianzi University, Hangzhou Zhejiang 310018, China
| | - Li-hua Li
- College of Life Information Science & Instrument Engineering, Hangzhou Dianzi University, Hangzhou Zhejiang 310018, China
| | - Yong Yang
- College of Life Information Science & Instrument Engineering, Hangzhou Dianzi University, Hangzhou Zhejiang 310018, China
| |
Collapse
|
38
|
Abstract
The term encephalopathy encompasses a wide variety of syndromes caused by a large number of different toxic, metabolic, and degenerative derangements. Despite advances in intensive medical care and new diagnostic procedures, encephalopathy remains a frequent and underrecognized critical medical condition with high morbidity and mortality. Electroencephalography (EEG) enables rapid bedside electrophysiological measurements of brain dysfunction and complements clinical and neuroimaging assessment of encephalopathic patients. Both progressive slowing of EEG background activity with increasing cerebral compromise and decreased EEG reactivity to external stimuli provide important diagnostic and prognostic information. The aim of this review was to provide an overview of the diagnostic and prognostic value of EEG in encephalopathic patients.
Collapse
|
39
|
Su YY, Wang M, Chen WB, Fu P, Yang QL, Li HL, Wang XM, Wang L. Early prediction of poor outcome in severe hemispheric stroke by EEG patterns and gradings. Neurol Res 2014; 35:512-6. [PMID: 23711325 DOI: 10.1179/1743132813y.0000000205] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES To find out the EEG abnormal patterns in massive cerebral hemispheric infarction (MCHI) and their correlation with poor outcome, and to construct an EEG grading for predicting the outcome of MCHI patients. METHODS Between 2000 and 2010, 162 patients with MCHI who met the selection criterions were selected for this study. All the patients underwent EEG examinations within 3 days after stroke onset and repeated on day 2 and 3. We classified the EEG recordings into 9 patterns and anglicized the correlation between EEG patterns and outcome. Then according to the results of the correlation between EEG patterns and outcome we constructed an EEG grading for predicting the outcome of MCHI patients. RESULTS We revealed that patterns of dominant alpha without reactivity, RAWOD, burst-suppression, α/θ-coma, epileptiform activity (without burst-suppression), and generalized suppression were correlated to poor outcome. We further modified the Young grading according to the correlation between EEG patterns and outcome. We found that the modified grading was superior to existing EEG gradings in predicting the outcome of MCHI patients, and it could predict the outcome of MCHI more accurately. CONCLUSIONS MCHI is common in N-ICU (Neurology Intensive Care Unit). The EEG analysis would detect the degree of brain lesion during the ischemia within the acute stage after stroke onset. The EEG evaluation might assist the neurophysicians to predict outcome of patients and make decisions on the treatments.
Collapse
Affiliation(s)
- Ying Ying Su
- Neurological Intensive Care Unit, Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Altwegg-Boussac T, Chavez M, Mahon S, Charpier S. Excitability and responsiveness of rat barrel cortex neurons in the presence and absence of spontaneous synaptic activity in vivo. J Physiol 2014; 592:3577-95. [PMID: 24732430 DOI: 10.1113/jphysiol.2013.270561] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The amplitude and temporal dynamics of spontaneous synaptic activity in the cerebral cortex vary as a function of brain states. To directly assess the impact of different ongoing synaptic activities on neocortical function, we performed in vivo intracellular recordings from barrel cortex neurons in rats under two pharmacological conditions generating either oscillatory or tonic synaptic drive. Cortical neurons membrane excitability and firing responses were compared, in the same neurons, before and after complete suppression of background synaptic drive following systemic injection of a high dose of anaesthetic. Compared to the oscillatory state, the tonic pattern resulted in a more depolarized and less fluctuating membrane potential (Vm), a lower input resistance (Rm) and steeper relations of firing frequency versus injected current (F-I). Whatever their temporal dynamics, suppression of background synaptic activities increased mean Vm, without affecting Rm, and induced a rightward shift of F-I curves. Both types of synaptic drive generated a high variability in current-induced firing rate and patterns in cortical neurons, which was much reduced after removal of spontaneous activity. These findings suggest that oscillatory and tonic synaptic patterns differentially facilitate the input-output function of cortical neurons but result in a similar moment-to-moment variability in spike responses to incoming depolarizing inputs.
Collapse
Affiliation(s)
- Tristan Altwegg-Boussac
- Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, UPMC; INSERM U 1127; CNRS UMR 7225, Hôpital Pitié-Salpêtrière, F-75013, Paris, France
| | - Mario Chavez
- Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, UPMC; INSERM U 1127; CNRS UMR 7225, Hôpital Pitié-Salpêtrière, F-75013, Paris, France
| | - Séverine Mahon
- Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, UPMC; INSERM U 1127; CNRS UMR 7225, Hôpital Pitié-Salpêtrière, F-75013, Paris, France
| | - Stéphane Charpier
- Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, UPMC; INSERM U 1127; CNRS UMR 7225, Hôpital Pitié-Salpêtrière, F-75013, Paris, France UPMC Univ Paris 06, F-75005, Paris, France
| |
Collapse
|
41
|
A review of long-term EEG monitoring in critically ill children with hypoxic-ischemic encephalopathy, congenital heart disease, ECMO, and stroke. J Clin Neurophysiol 2013; 30:134-42. [PMID: 23545764 DOI: 10.1097/wnp.0b013e3182872af9] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Continuous EEG monitoring is being used with increasing frequency in critically ill children with hypoxic ischemic encephalopathy, congenital heart disease, stroke, and extracorporeal membrane oxygenation (ECMO). The primary indication for EEG monitoring is to identify electrographic seizures and electrographic status epilepticus, which have been associated with worse outcome in some populations. A secondary indication is to provide prognostic information. This review summarizes the available data regarding continuous EEG monitoring in critically ill children with special attention to hypoxic ischemic encephalopathy, congenital heart disease, stroke, and children undergoing ECMO.
Collapse
|
42
|
Varotto G, Fazio P, Rossi Sebastiano D, Duran D, D'Incerti L, Parati E, Sattin D, Leonardi M, Franceschetti S, Panzica F. Altered resting state effective connectivity in long-standing vegetative state patients: an EEG study. Clin Neurophysiol 2013; 125:63-8. [PMID: 23927942 DOI: 10.1016/j.clinph.2013.06.016] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 05/21/2013] [Accepted: 06/11/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Recent evidence mainly based on hemodynamic measures suggests that the impairment of functional connections between different brain areas may help to clarify the neuronal dysfunction occurring in patients with disorders of consciousness (DOC). The aim of this study was to evaluate effective EEG connectivity in a cohort of 18 patients in a chronic vegetative state (VS) observed years after the occurrence of hypoxic (eight) and traumatic or hemorrhagic brain insult. METHODS we analysed the EEG signals recorded under resting conditions using a frequency domain linear index of connectivity (partial directed coherence: PDC) estimated from a multivariate autoregressive model. The results were compared with those obtained in ten healthy controls. RESULTS Our findings indicated significant connectivity changes in EEG activities in delta and alpha bands. The VS patients showed a significant and widespread decrease in delta band connectivity, whereas the alpha activity was hyper-connected in the central and posterior cortical regions. CONCLUSION These changes suggest the occurrence of severe circuitry derangements probably due to the loose control of the subcortical connections. The alpha hyper-synchronisation may be due to simplified networks mainly involving the short-range connections between intrinsically oscillatory cortical neurons that generate aberrant EEG alpha sources. This increased connectivity may be interpreted as a reduction in information capacity, implying an increasing prevalence of stereotypic activity patterns. SIGNIFICANCE Our observations suggest a remarkable rearrangement of connectivity in patients with long-standing VS. We hypothesize that in persistent VS, after a first period characterized by a breakdown of cortical connectivity, neurodegenerative processes, largely independent from the type of initial insult, lead to cortex de-afferentation and to a severe reduction of possible cortical activity patterns and states.
Collapse
Affiliation(s)
- Giulia Varotto
- Dept. of Neurophysiology and Diagnostic Epileptology, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| | - Patrik Fazio
- Dept. of Neurophysiology and Diagnostic Epileptology, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy; Dept. of Medical and Surgical Sciences of Communication and Behaviour, Neurology Section, University of Ferrara, Italy
| | - Davide Rossi Sebastiano
- Dept. of Neurophysiology and Diagnostic Epileptology, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| | - Dunja Duran
- Dept. of Neurophysiology and Diagnostic Epileptology, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| | - Ludovico D'Incerti
- Dept. of Neuroradiology, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| | - Eugenio Parati
- Dept. of Cerebrovascular Diseases, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| | - Davide Sattin
- Unit of Neurology, Public Health, Disability Unit, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy; Coma Research Centre, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| | - Matilde Leonardi
- Unit of Neurology, Public Health, Disability Unit, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy; Coma Research Centre, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| | - Silvana Franceschetti
- Dept. of Neurophysiology and Diagnostic Epileptology, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| | - Ferruccio Panzica
- Dept. of Neurophysiology and Diagnostic Epileptology, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy.
| |
Collapse
|
43
|
Cologan V, Drouot X, Parapatics S, Delorme A, Gruber G, Moonen G, Laureys S. Sleep in the unresponsive wakefulness syndrome and minimally conscious state. J Neurotrauma 2013; 30:339-46. [PMID: 23121471 DOI: 10.1089/neu.2012.2654] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The goal of our study was to investigate different aspects of sleep, namely the sleep-wake cycle and sleep stages, in the vegetative state/unresponsive wakefulness syndrome (VS/UWS), and minimally conscious state (MCS). A 24-h polysomnography was performed in 20 patients who were in a UWS (n=10) or in a MCS (n=10) because of brain injury. The data were first tested for the presence of a sleep-wake cycle, and the observed sleep patterns were compared with standard scoring criteria. Sleep spindles, slow wave sleep, and rapid eye movement sleep were quantified and their clinical value was investigated. According to our results, an electrophysiological sleep-wake cycle was identified in five MCS and three VS/UWS patients. Sleep stages did not always match the standard scoring criteria, which therefore needed to be adapted. Sleep spindles were present more in patients who clinically improved within 6 months. Slow wave sleep was present in eight MCS and three VS/UWS patients but never in the ischemic etiology. Rapid eye movement sleep, and therefore dreaming that is a form of consciousness, was present in all MCS and three VS/UWS patients. In conclusion, the presence of alternating periods of eyes-open/eyes-closed cycles does not necessarily imply preserved electrophysiological sleep architecture in the UWS and MCS, contrary to previous definition. The investigation of sleep is a little studied yet simple and informative way to evaluate the integrity of residual brain function in patients with disorders of consciousness with possible clinical diagnostic and prognostic implications.
Collapse
Affiliation(s)
- Victor Cologan
- Coma Science Group, Cyclotron Research Center, University of Liège, Belgium.
| | | | | | | | | | | | | |
Collapse
|
44
|
Vendrame M, Kothare SV. Recognizing Normal, Abnormal, and Benign Nonepileptiform Electroencephalographic Activity and Patterns in Polysomnographic Recordings. Sleep Med Clin 2012. [DOI: 10.1016/j.jsmc.2011.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
45
|
Interobserver reproducibility of electroencephalogram interpretation in critically ill children. J Clin Neurophysiol 2011; 28:15-9. [PMID: 21221016 DOI: 10.1097/wnp.0b013e3182051123] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Correct outcome prediction after cardiac arrest in children may improve clinical decision making and family counseling. Investigators have used EEG to predict outcome with varying success, but a limiting issue is the potential lack of reproducibility of EEG interpretation. Therefore, the authors aimed to evaluate interobserver agreement using standardized terminology in the interpretation of EEG tracings obtained from critically ill children after cardiac arrest. Three pediatric neurophysiologists scored 74 EEG samples using standardized categories, terminology, and interpretation rules. Interobserver agreement was evaluated using kappa and intraclass correlation coefficients. Agreement was substantial for the categories of continuity, burst suppression, sleep architecture, and overall rating. Agreement was moderate for seizure occurrence and interictal epileptiform discharge type. Agreement was fair for interictal epileptiform discharge presence, beta activity, predominant frequency, and fastest frequency. Agreement was slight for maximum voltage and focal slowing presence. The variability of interrater agreement suggests that some EEG features are superior to others for use in a predictive algorithm. Using only reproducible EEG features is needed to ensure the most accurate and consistent predictions. Because even seizure identification had only moderate agreement, studies of nonconvulsive seizures in critically ill patients must be conducted and interpreted cautiously.
Collapse
|
46
|
LO MENTZUNG, TSAI PINGHUANG, LIN PEIFENG, LIN CHEN, HSIN YUELOONG. THE NONLINEAR AND NONSTATIONARY PROPERTIES IN EEG SIGNALS: PROBING THE COMPLEX FLUCTUATIONS BY HILBERT–HUANG TRANSFORM. ACTA ACUST UNITED AC 2011. [DOI: 10.1142/s1793536909000199] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The analysis of biological fluctuations provides an excellent route to probe the underlying mechanisms in maintaining internal homeostasis of the body, especially under the challenges of the ever-changing environment or disease processes. However, the features of nonlinearity and nonstationarity in physiological time series limit the reliability of the conventional analysis. Hilbert–Huang transform (HHT), based on nonlinear theory, is an innovative approach to extract the dynamic information at different time scales, in particular, from nonstationary signals. In this paper, HHT is introduced to analyze the alpha waves of human's electroencephalography (EEG), which seemly oscillate regularly between 8 and 12 Hz in healthy subject but getting irregular or disappeared in different demented status. Furthermore, conventional time–frequency analyses are adopted to collate the results from those methods and HHT. Finally, the potential usages of HHT are demonstrated in characterizing the biological signals qualitatively and quantitatively, including stationarity analysis, instantaneous frequency and amplitude modulation or correlation analysis. Such applications on EEG have successively disclosed the differences of alpha rhythms between normal and demented brains and the nonlinear characteristics of the underlying mechanisms. Hopefully, in addition to empower the studies of EEG varied in diseased, aging, and physiological processes, these methods might find other applications in EEG analysis.
Collapse
Affiliation(s)
- MEN-TZUNG LO
- Research Center for Adaptive Data Analysis, National Central University, Chungli, Taiwan, ROC
| | - PING-HUANG TSAI
- Neurology Department, National Yang-Ming University Hospital, Yi-Lan, Taiwan, ROC
- Graduate Institute of Biomedical Electronics and Bioinformations, National Taiwan University, Taiwan, ROC
- National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - PEI-FENG LIN
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taiwan, ROC
- Department of Health, Executive Yuan, Tainan Hospital, Tainan, Taiwan, ROC
| | - CHEN LIN
- Research Center for Adaptive Data Analysis, National Central University, Chungli, Taiwan, ROC
- Institute of Systems Biology and Bioinformatics, National Central University, Taoyuan, Taiwan, ROC
| | - YUE LOONG HSIN
- Neurology, Buddhist Tzu Chi General Hospital, Hualein, Taiwan, ROC
| |
Collapse
|
47
|
Kessler SK, Topjian AA, Gutierrez-Colina AM, Ichord RN, Donnelly M, Nadkarni VM, Berg RA, Dlugos DJ, Clancy RR, Abend NS. Short-term outcome prediction by electroencephalographic features in children treated with therapeutic hypothermia after cardiac arrest. Neurocrit Care 2011; 14:37-43. [PMID: 20890677 DOI: 10.1007/s12028-010-9450-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Electroencephalographic (EEG) features may provide objective data regarding prognosis in children resuscitated from cardiac arrest (CA), but therapeutic hypothermia (TH) may impact its predictive value. We aimed to determine whether specific EEG features were predictive of short-term outcome in children treated with TH after CA, both during hypothermia and after return to normothermia. METHODS Thirty-five children managed with a standard clinical TH algorithm after CA were prospectively enrolled. EEG recordings were scored in a standardized manner and categorized. EEG category 1 consisted of continuous and reactive tracings. EEG category 2 consisted of continuous but unreactive tracings. EEG category 3 included those with any degree of discontinuity, burst suppression, or lack of cerebral activity. The primary outcome was unfavorable short-term outcome defined as Pediatric Cerebral Performance Category score of 4-6 (severe disability, vegetative, death) at hospital discharge. Univariate analyses of the association between EEG category and outcome was performed using logistic regression. RESULTS For tracings obtained during hypothermia, patients with EEGs in categories 2 or 3 were far more likely to have poor outcome than those in category 1 (OR 10.7, P = 0.023 and OR 35, P = 0.004, respectively). Similarly, for tracings obtained during normothermia, patients with EEGs in categories 2 or 3 were far more likely to have poor outcomes than those in category 1 (OR 27, P = 0.006 and OR 18, P = 0.02, respectively). CONCLUSIONS A simple EEG classification scheme has predictive value for short-term outcome in children undergoing TH after CA.
Collapse
Affiliation(s)
- Sudha Kilaru Kessler
- Division of Neurology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Wu DY, Cai G, Yuan Y, Liu L, Li GQ, Song WQ, Wang MB. Application of nonlinear dynamics analysis in assessing unconsciousness: A preliminary study. Clin Neurophysiol 2011; 122:490-498. [DOI: 10.1016/j.clinph.2010.05.036] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Revised: 04/06/2010] [Accepted: 05/30/2010] [Indexed: 11/27/2022]
|
49
|
Endogenous adenosine A1 receptor activation underlies the transient post-ischemic rhythmic delta EEG activity. Clin Neurophysiol 2010; 122:1117-26. [PMID: 20947418 DOI: 10.1016/j.clinph.2010.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 09/19/2010] [Accepted: 09/20/2010] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Emergence of slow EEG rhythms within the delta frequency band following an ischemic insult of the brain has long been considered a marker of irreversible anatomical damage. Here we investigated whether ischemic adenosine release and subsequent functional inhibition via the adenosine A(1) receptor (A(1)R) contributes to post-ischemic delta activity. METHODS Rats were subjected to episodes of non-injuring transient global cerebral ischemia (GCI) under chloral hydrate anesthesia. RESULTS We found that a GCI lasting only 10s was enough to induce a brief discharge of rhythmic delta activity (RDA) with a peak frequency just below 1 Hz quantified as an increase by twofold of the 0.5-1.5 Hz spectral power. This post-ischemic RDA did not occur following administration of the A(1)R antagonist 8-cyclopentyl-1,3-dipropylxanthine. Nevertheless, a similar RDA could be induced in rats not subjected to GCI, by systemic administration of the A(1)R agonist N(6)-cyclopentyladenosine. CONCLUSIONS Our data suggest that A(1)R activation at levels that occur following cerebral ischemia underlies the transient post-ischemic RDA. SIGNIFICANCE It is likely that the functional, thus potentially reversible, synaptic disconnection by A(1)R activation promotes slow oscillations in the cortical networks. This should be accounted for in the interpretation of early post-ischemic EEG delta activity.
Collapse
|
50
|
Borges MA, Botós HJ, Bastos RF, Godoy MF, Marchi NSAD. Emergency EEG: study of survival. ARQUIVOS DE NEURO-PSIQUIATRIA 2010; 68:174-8. [PMID: 20464280 DOI: 10.1590/s0004-282x2010000200004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Accepted: 10/30/2009] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To determine the survival rate according to the main findings of emergency electroencephalography (EEGs) of patients treated in a tertiary hospital. METHOD In this prospective study, the findings of consecutive emergency EEGs performed on inpatients in Hospital de Base in São José do Rio Preto, Brazil were correlated with survival utilizing Kaplan-Meyer survival curves. RESULTS A total of 681 patients with an average age of 42 years old (1 day to 96 years) were evaluated, of which 406 were male. The main reasons for EEGs were epileptic seizures (221 cases), hepatic encephalopathy [116 cases of which 85 (73.3%) were men, p-value=0.001], status epilepticus (104 cases) and impaired consciousness (78 cases). The underlying disease was confirmed in 578 (84.3%) cases with 119 (17.5%) having liver disease [91 (76.0%) were men, p-value=0.001], 105 (15.4%) suffering strokes, 67 (9.9%) having metabolic disorders, 51 (7.5%) central nervous system infections and 49 (7.2%) epilepsy. In the three months following EEG, a survival rate of 75% was found in patients with normal, discreet slow activity or intermittent rhythmic delta activity EEGs, of 50% for those with continuous delta activity and generalized epileptiform discharges, and of 25% for those with burst-suppression, diffuse depression, and in alpha/theta-pattern coma. Death was pronounced immediately in patients with isoelectric EEGs. CONCLUSION The main findings of EEGs, differentiated different survival rates and are thus a good prognostic tool for patients examined in emergencies.
Collapse
Affiliation(s)
- Moacir Alves Borges
- Neuroscience Departmen, Medicine School in São José do Rio Preto, São José do Rio Preto, SP, Brazil.
| | | | | | | | | |
Collapse
|