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Critical Care EEG

Christa B Swisher, Saurabh R Sinha
PURPOSE: Quantitative EEG (QEEG) can be used to assist with review of large amounts of data generated by critical care continuous EEG monitoring. This study aimed to identify current practices regarding the use of QEEG in critical care continuous EEG monitoring of critical care patients. METHODS: An online survey was sent to 796 members of the American Clinical Neurophysiology Society (ACNS), instructing only neurophysiologists to participate. RESULTS: The survey was completed by 75 neurophysiologists that use QEEG in their practice...
December 2016: Journal of Clinical Neurophysiology: Official Publication of the American Electroencephalographic Society
Frederik Van de Steen, Luca Faes, Esin Karahan, Jitkomut Songsiri, Pedro A Valdes-Sosa, Daniele Marinazzo
Many different analysis techniques have been developed and applied to EEG recordings that allow one to investigate how different brain areas interact. One particular class of methods, based on the linear parametric representation of multiple interacting time series, is widely used to study causal connectivity in the brain. However, the results obtained by these methods should be interpreted with great care. The goal of this paper is to show, both theoretically and using simulations, that results obtained by applying causal connectivity measures on the sensor (scalp) time series do not allow interpretation in terms of interacting brain sources...
November 30, 2016: Brain Topography
Hajime Yoshimura, Riki Matsumoto, Hiroyuki Ueda, Koichi Ariyoshi, Michi Kawamoto, Junko Ishii, Akio Ikeda, Ryosuke Takahashi, Nobuo Kohara
OBJECTIVE: To delineate the clinical characteristics and functional outcome of status epilepticus (SE) in elderly people, and elucidate prognostic implications of SE-associated rhythmic and periodic patterns (RPPs) in electroencephalography and hyperintensities on diffusion-weighted imaging. METHODS: We retrospectively investigated 107 consecutive patients with SE aged≥65years in a comprehensive community hospital. RPPs were classified using the 2012 American Clinical Neurophysiology Society's Standardized Critical Care EEG Terminology...
November 15, 2016: Journal of the Neurological Sciences
Yannick Fogang, Benjamin Legros, Chantal Depondt, Nicolas Mavroudakis, Nicolas Gaspard
INTRODUCTION: Seizures are common in critically ill patients and prevalence can exceed 30% in the neuro-intensive care unit (ICU). Continuous EEG monitoring (cEEG) is the gold standard for seizure detection in critically ill patients. OBJECTIVES: To determine the yield of intermittent EEG (iEEG) to detect critically ill adult patients with seizures and to identify the factors that affect this yield. METHODS: We retrospectively analyzed cEEG data and medical records from 977 consecutive critically ill patients undergoing cEEG...
October 19, 2016: Neurophysiologie Clinique, Clinical Neurophysiology
Kelsee Halpin, Ryan McDonough, Patria Alba, Jared Halpin, Vivekanand Singh, Yun Yan
BACKGROUND: Insulinoma is a rare diagnosis in the general population with estimates of 1 in 250,000 people per year. Reports of these pancreatic islet cell tumors are even more unusual in children and adolescents. Chronic hypoglycemia due to an insulinoma often presents with neuroglycopenic symptoms that can easily be overlooked, especially in adolescents where nonspecific complaints are common. This may result in delayed diagnosis with prolonged periods of untreated hypoglycemia and associated complications...
2016: International Journal of Pediatric Endocrinology
Hiba A Haider, Rosana Esteller, Cecil D Hahn, M Brandon Westover, Jonathan J Halford, Jong W Lee, Mouhsin M Shafi, Nicolas Gaspard, Susan T Herman, Elizabeth E Gerard, Lawrence J Hirsch, Joshua A Ehrenberg, Suzette M LaRoche
OBJECTIVE: To evaluate the sensitivity of quantitative EEG (QEEG) for electrographic seizure identification in the intensive care unit (ICU). METHODS: Six-hour EEG epochs chosen from 15 patients underwent transformation into QEEG displays. Each epoch was reviewed in 3 formats: raw EEG, QEEG + raw, and QEEG-only. Epochs were also analyzed by a proprietary seizure detection algorithm. Nine neurophysiologists reviewed raw EEGs to identify seizures to serve as the gold standard...
August 30, 2016: Neurology
Danny Eytan, Elizabeth W Pang, Sam M Doesburg, Vera Nenadovic, Bojan Gavrilovic, Peter Laussen, Anne-Marie Guerguerian
Acute brain injury is a common cause of death and critical illness in children and young adults. Fundamental management focuses on early characterization of the extent of injury and optimizing recovery by preventing secondary damage during the days following the primary injury. Currently, bedside technology for measuring neurological function is mainly limited to using electroencephalography (EEG) for detection of seizures and encephalopathic features, and evoked potentials. We present a proof of concept study in patients with acute brain injury in the intensive care setting, featuring a bedside functional imaging set-up designed to map cortical brain activation patterns by combining high density EEG recordings, multi-modal sensory stimulation (auditory, visual, and somatosensory), and EEG source modeling...
2016: NeuroImage: Clinical
Charles B Mikell, Timothy G Dyster, Jan Claassen
Seizures commonly occur in a variety of serious neurological illnesses, and lead to additional morbidity and worsened outcomes. Recently, it has become clear that not all seizures in the acute brain injury setting are evident on scalp EEG. To address this, we have developed a protocol for depth electrode placement in the neuro-intensive care unit for patients in whom the clinical suspicion of occult seizures is high. In the current manuscript, we review the literature on depth EEG monitoring for ictal events in critically-ill, unconscious patients, focusing on the incidence of seizures not detected with scalp EEG in various conditions...
October 2016: Seizure: the Journal of the British Epilepsy Association
Vivek Kalra, Shahul Sikkander Shaw, Stacey Dixon, Divyen K Shah, Paul Clarke
UNLABELLED: Cerebral function monitoring is widely used in neonatal intensive care, but its potential role in assessment of older infants is scarcely reported. We reviewed the use of cerebral function monitoring on a general paediatric ward in a series of young infants admitted with abnormal movements. Review of the amplitude-integrated EEG obtained by cerebral function monitoring revealed electrographic seizures in four of seven infants monitored. We also surveyed general paediatric wards in hospitals in our region of the UK to ask about current use of cerebral function monitoring and local availability of formal electroencephalography services...
August 2016: European Journal of Pediatrics
Stephane Legriel, Gretchen M Brophy
The aim of this systematic review was to describe particularities in epidemiology, outcome, and management modalities in the older adult population with status epilepticus. There is a higher incidence of status epilepticus in the older adult population, and it commonly has a nonconvulsive presentation. Diagnosis in this population may be difficult and requires an unrestricted use of EEG. Short and long term associated-mortality are high, and age over 60 years is an independent factor associated with poor outcome...
2016: Journal of Clinical Medicine
Susana Vacas, Erin McInrue, Michael A Gropper, Mervyn Maze, Rochelle Zak, Eunjung Lim, Jacqueline M Leung
BACKGROUND: Sleep disruption in critically ill adults can result in acute decrements in cognitive function, including delirium, but it is underdiagnosed in the setting of the intensive care unit (ICU). Although sleep stages can be assessed by polysomnography (PSG), acquisition and interpretation of PSG is costly, is labor intensive, is difficult to do over an extended period of time with critically ill patients (multiple days of continuous recording), and may interfere with patient care...
July 2016: Anesthesia and Analgesia
J G Bogaarts, D M W Hilkman, E D Gommer, V H J M van Kranen-Mastenbroek, J P H Reulen
Continuous electroencephalographic monitoring of critically ill patients is an established procedure in intensive care units. Seizure detection algorithms, such as support vector machines (SVM), play a prominent role in this procedure. To correct for inter-human differences in EEG characteristics, as well as for intra-human EEG variability over time, dynamic EEG feature normalization is essential. Recently, the median decaying memory (MDM) approach was determined to be the best method of normalization. MDM uses a sliding baseline buffer of EEG epochs to calculate feature normalization constants...
December 2016: Medical & Biological Engineering & Computing
Sherri A Braksick, David B Burkholder, Spyridoula Tsetsou, Laurence Martineau, Jay Mandrekar, Andrea O Rossetti, Martin Savard, Jeffrey W Britton, Alejandro A Rabinstein
IMPORTANCE: The implications of stimulus-induced rhythmic, periodic, or ictal discharges (SIRPIDs) sometimes found on prolonged electroencephalographic (EEG) recordings are uncertain. OBJECTIVE: To evaluate the incidence of SIRPIDs and their clinical implications in critically ill patients. DESIGN, SETTING, AND PARTICIPANTS: A multicenter, international retrospective study was performed from October 1, 2012, through September 30, 2014, of consecutive adult patients hospitalized in intensive care units with alteration of consciousness who underwent EEG recordings at 3 separate centers...
May 1, 2016: JAMA Neurology
Franz Fürbass, Johannes Herta, Johannes Koren, M Brandon Westover, Manfred M Hartmann, Andreas Gruber, Christoph Baumgartner, Tilmann Kluge
OBJECTIVE: To develop a computational method to detect and quantify burst suppression patterns (BSP) in the EEGs of critical care patients. A multi-center validation study was performed to assess the detection performance of the method. METHODS: The fully automatic method scans the EEG for discontinuous patterns and shows detected BSP and quantitative information on a trending display in real-time. The method is designed to work without setting any patient specific parameters and to be insensitive to EEG artifacts and periodic patterns...
April 2016: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
Jong Woo Lee, Suzette LaRoche, Hyunmi Choi, Andres A Rodriguez Ruiz, Evan Fertig, Jeffrey M Politsky, Susan T Herman, Tobias Loddenkemper, Arnold J Sansevere, Pearce J Korb, Nicholas S Abend, Joshua L Goldstein, Saurabh R Sinha, Keith E Dombrowski, Eva K Ritzl, Michael B Westover, Jay R Gavvala, Elizabeth E Gerard, Sarah E Schmitt, Jerzy P Szaflarski, Kan Ding, Kevin F Haas, Richard Buchsbaum, Lawrence J Hirsch, Courtney J Wusthoff, Jennifer L Hopp, Cecil D Hahn
PURPOSE: The rapid expansion of the use of continuous critical care electroencephalogram (cEEG) monitoring and resulting multicenter research studies through the Critical Care EEG Monitoring Research Consortium has created the need for a collaborative data sharing mechanism and repository. The authors describe the development of a research database incorporating the American Clinical Neurophysiology Society standardized terminology for critical care EEG monitoring. The database includes flexible report generation tools that allow for daily clinical use...
April 2016: Journal of Clinical Neurophysiology: Official Publication of the American Electroencephalographic Society
Yujie Ma, Bin Ouyang, Xiangdong Guan
OBJECTIVE: To observe the quantitative electroencephalogram (qEEG) characteristics of the patients with septic shock in intensive care unit (ICU), and to find the early presence and severity of septic-associated encephalopathy (SAE) in these patients. METHODS: During November 2014 to August 2015, 26 cases with septic shock were included from the ICU of the First Affiliated Hospital, Sun Yat-sen University.During the same period, 14 healthy volunteers were included as control...
January 19, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Adithya Sivaraju, Emily J Gilmore
Continuous electroencephalographic (EEG) monitoring has become an invaluable tool for the assessment of brain function in critically ill patients. However, interpretation of EEG waveforms, especially in the intensive care unit (ICU) setting is fraught with ambiguity. The term ictal-interictal continuum encompasses EEG patterns that are potentially harmful and can cause neuronal injury. There are no clear guidelines on how to treat EEG patterns that lie on this continuum. We advocate the following approaches in a step wise manner: (1) identify and exclude clear electrographic seizures and status epilepticus (SE), i...
February 2016: Current Treatment Options in Neurology
Stephen A Thompson, Stephen Hantus
PURPOSE: Pharmacologic sedation is often used to induce burst suppression in cases of refractory status epilepticus, but there is little evidence to guide the weaning of sedation. Similarly, the morphologic feature of bursts is of unknown clinical relevance. Recently, the standardized American Clinical Neurophysiology Society terminology of critical care EEG introduced the term highly epileptiform bursts (HEBs). Knowing the association of HEBs with seizure may direct the therapy for refractory status epilepticus...
February 2016: Journal of Clinical Neurophysiology: Official Publication of the American Electroencephalographic Society
Johannes P Koren, Johannes Herta, Susanne Pirker, Franz Fürbass, Manfred Hartmann, Tilmann Kluge, Christoph Baumgartner
OBJECTIVES: To study periodic and rhythmic EEG patterns classified according to Standardized Critical Care EEG Terminology (SCCET) of the American Clinical Neurophysiology Society and their relationship to electrographic seizures. METHODS: We classified 655 routine EEGs in 371 consecutive critically ill neurological patients into (1) normal EEGs or EEGs with non-specific abnormalities or interictal epileptiform discharges, (2) EEGs containing unequivocal ictal EEG patterns, and (3) EEGs showing rhythmic and periodic EEG patterns of 'ictal-interictal uncertainty' (RPPIIIU) according to SCCET...
February 2016: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
George Touloumes, Elliot Morse, William C Chen, Leah Gober, Jennifer Dente, Rachel Lilenbaum, Emily Katzenstein, Ashley Pacelli, Emily Johnson, Yang Si, Adithya Sivaraju, Eric Grover, Rebecca Khozein, Courtney Cunningham, Lawrence J Hirsch, Hal Blumenfeld
Evaluation of behavioral impairment during epileptic seizures is critical for medical decision making, including accurate diagnosis, recommendations for driving, and presurgical evaluation. We investigated the quality of behavioral testing during inpatient video-electroencephalography (EEG) monitoring at an established epilepsy center, and introduce a technical innovation that may improve clinical care. We retrospectively reviewed video-EEG data from 152 seizures in 33 adult or pediatric patients admitted for video-EEG monitoring...
January 2016: Epilepsia
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