Current Clinical Evidence Supporting the Use of Continuous EEG Monitoring for Delayed Cerebral Ischemia Detection

2016 ◽  
Vol 33 (3) ◽  
pp. 211-216 ◽  
Author(s):  
Nicolas Gaspard
Keyword(s):  
Cerebral Ischemia ◽  
Clinical Evidence ◽  
Delayed Cerebral Ischemia ◽  
Eeg Monitoring ◽  
Continuous Eeg ◽  
Continuous Eeg Monitoring

Combining Transcranial Doppler and EEG Data to Predict Delayed Cerebral Ischemia After Subarachnoid Hemorrhage

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000013126
Author(s):  
Hsin Yi Chen ◽  
Jonathan Elmer ◽  
Sahar F. Zafar ◽  
Manohar Ghanta ◽  
Valdery Moura Junior ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Ischemia ◽  
Transcranial Doppler ◽  
Delayed Cerebral Ischemia ◽  
Eeg Monitoring ◽  
Support Tool ◽  
Epileptiform Discharges ◽  
Eeg Data ◽  
Continuous Eeg

Background and Objectives:Delayed cerebral ischemia (DCI) is the leading complication of subarachnoid hemorrhage (SAH). Because DCI was traditionally thought to be caused by large vessel vasospasm, transcranial Doppler ultrasounds (TCDs) have been the standard of care. Continuous EEG has emerged as a promising complementary monitoring modality and predicts increased DCI risk. Our objective was to determine whether combining EEG and TCD data improves prediction of DCI after SAH. We hypothesize that integrating these diagnostic modalities improves DCI prediction.Methods:We retrospectively assessed patients with moderate-severe SAH (2011-2015, Fisher=3-4 or Hunt-Hess=4-5) who had both prospective TCD and EEG acquisition during hospitalization. Middle cerebral artery (MCA) peak systolic velocities (PSV) and the presence or absence of epileptiform abnormalities (EA), defined as seizures, epileptiform discharges, and rhythmic/periodic activity, were recorded daily. Logistic regressions were used to identify significant covariates of EA and TCD to predict DCI. Group-Based Trajectory Modeling (GBTM) was used to account for changes over time by identifying distinct group trajectories of MCA PSV and EA associated with DCI risk.Results:We assessed 107 patients, and DCI developed in 56 (51.9%). Univariate predictors of DCI are presence of high-MCA velocity (PSV≥200cm/s, Se=27%, Sp=89%) and EA (Se=66%, Sp=62%) both on or before day 3. Two univariate GBTM trajectories of EA predicted DCI (Se=64%, Sp=62.75%). Logistic regression and GBTM models using both TCD and EEG monitoring performed better. The best logistic regression and GBTM models used both TCD and EEG data, Hunt-Hess score at admission, and aneurysm treatment as predictors of DCI (Logistic Regression: Se=90%, Sp=70%; GBTM: Se=89%, Sp=67%).Discussion:EEG and TCD biomarkers combined provide the best prediction of DCI. The conjunction of clinical variables with the timing of EA and high-MCA velocities improved model performance. These results suggest that TCD and cEEG are promising complementary monitoring modalities for DCI prediction. Our model has potential to serve as a decision support tool in SAH management.Classification of Evidence:This study provides Class II evidence that combined TCD and EEG monitoring can identify delayed cerebral ischemia after subarachnoid hemorrhage.

scholarly journals Continuous EEG Monitoring in the Intensive Care Unit

1998 ◽  
Vol 25 (S1) ◽  
pp. S12-S15 ◽  
Author(s):  
John Kay
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Eeg Monitoring ◽  
General Icus ◽  
Continuous Eeg ◽  
Nonconvulsive Seizures ◽  
Continuous Eeg Monitoring ◽  
Clinical Problems

AbstractBackground:Electroencephalography (EEG) is playing an increasingly important role in the management of comatose patients in the intensive care unit.Methods:The techniques of EEG monitoring are reviewed. Initially, standard, discontinuous recordings were performed in intensive care units (ICUs). Later, continuous displays of “raw EEG” (CEEG) were used. More recently, the addition of quantitative techniques allowed for more effective reading.Results and Conclusions:Applications of continuous EEG to clinical problems are discussed. The most useful role of CEEG appears to be the detection and management of nonconvulsive seizures. There is a need for controlled studies to assess the role for CEEG in neuro-ICUs and general ICUs.

Predictive Value of Early Continuous Electroencephalogram Monitoring in Ventilated Preterm Infants With Intraventricular Hemorrhage

PEDIATRICS ◽  
1988 ◽  
Vol 82 (3) ◽  
pp. 337-343
Author(s):  
J. Connell ◽  
L. de Vries ◽  
R. Oozeer ◽  
R. Regev ◽  
L. M.S. Dubowitz ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Intraventricular Hemorrhage ◽  
Eeg Monitoring ◽  
Mechanically Ventilated ◽  
Functional Correlation ◽  
Continuous Eeg ◽  
Continuous Eeg Monitoring ◽  
A Prospective Study ◽  
Ultrasound Evidence ◽  
Significant Data

The contribution of early continuous fourchannel EEG monitoring to the evaluation of intraventricular hemorrhage in acutely ill preterm infants mechanically ventilated for acute respiratory distress was assessed in a prospective study of 54 infants of less than 34 weeks' gestation. Early abnormal EEG results correlated significantly with later outcome. They often preceded ultrasound evidence of hemorrhage and provided prognostically significant functional correlation with the grade of hemorrhage. Continuous EEG monitoring allows collection of significant data with minimal interference and could contribute to clinical management of high-risk preterm infants.

Abstract TMP99: Pediatric Intracerebral Hemorrhage: Acute Symptomatic Seizures and Epilepsy

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Lauren A Beslow ◽  
Nicholas S Abend ◽  
Melissa C Gindville ◽  
Rachel A Bastian ◽  
Daniel J Licht ◽  
...  
Keyword(s):  
Risk Factor ◽  
Intracerebral Hemorrhage ◽  
Tertiary Care ◽  
Rank Test ◽  
Eeg Monitoring ◽  
Free Survival ◽  
Continuous Eeg ◽  
Continuous Eeg Monitoring ◽  
Symptomatic Seizures ◽  
Acute Symptomatic Seizures

Background and Objectives: We aimed to define the incidence of acute symptomatic seizures and of remote symptomatic seizures and epilepsy after spontaneous pediatric intracerebral hemorrhage (ICH). Methods: Pediatric patients with spontaneous ICH presenting between 2007 and 2012 at three tertiary care centers were prospectively identified. Acute symptomatic seizures were defined as seizures occurring from presentation to 7 days after ICH. Survival analysis was used to assess development of a first remote symptomatic seizure and epilepsy (2 or more unprovoked seizures >7 days after ICH). Log-rank tests were used to examine putative risk factors for development of remote symptomatic seizures and epilepsy. Results: Seventy-three pediatric subjects with spontaneous ICH were identified, including 20 perinatal (≥37 weeks gestation to 28 days) and 53 childhood subjects (>28 days to <18 years). Acute symptomatic seizures occurred in 12 (60%) perinatal and 23 (43%) childhood subjects, p=.29, Fisher’s exact. Median age of childhood subjects with acute symptomatic seizures was younger than those without (2.2 versus 10.8 years, p=.006, rank-sum). Electrographic-only seizures occurred in 28% of 32 subjects who had continuous EEG monitoring. Follow-up was not different between perinatal and childhood subjects (median 371 versus 340 days), p=.68, rank-sum. One and two-year remote symptomatic seizure-free survival were 82% (95% CI 68-91%) and 67% (95% CI 46-82%). One and two-year epilepsy-free survival were 96% (95% CI 83-99%) and 87% (95% CI 65-95%). Elevated intracranial pressure (ICP) requiring urgent intervention was a risk factor for remote symptomatic seizures and epilepsy (p=.024 and p=.037, log-rank test). Conclusions: Acute symptomatic seizures are common in both perinatal and childhood ICH. Continuous EEG monitoring may identify electrographic-only seizures in some subjects. By two-years after ICH it is estimated that about one-third of patients will have a single remote symptomatic seizures and that about 13% will develop epilepsy. Elevated ICP requiring intervention is a risk factor for remote symptomatic seizures and epilepsy.

Continuous EEG Monitoring and Quantitative EEG Techniques

2019 ◽  
pp. 79-109
Author(s):  
Naiara Garcia-Losarcos ◽  
Aditya Vuppala ◽  
Kenneth Loparo
Keyword(s):  
Quantitative Eeg ◽  
Eeg Monitoring ◽  
Continuous Eeg ◽  
Continuous Eeg Monitoring

EEG Trend Analysis in the ICU

2016 ◽  
pp. 209-221
Author(s):  
Amy Z. Crepeau
Keyword(s):  
Seizure Detection ◽  
Quantitative Eeg ◽  
Eeg Monitoring ◽  
Multiple Sources ◽  
Periodic Patterns ◽  
Continuous Eeg ◽  
Continuous Eeg Monitoring ◽  
It Support ◽  
Special Environment ◽  
Epilepsy Monitoring

Continuous EEG monitoring can increase the detection of subclinical seizures, and is important in managing nonconvulsive status epilepticus. In the ICU it presents challenges not routinely encountered in the outpatient EEG laboratory or the epilepsy monitoring unit: multiple sources of artifact, and the need for imaging-compatible electrodes and a robust IT support system. Rhythmic and periodic patterns of indeterminate significance are encountered. There is much debate as to the true significance of these patterns, and clinical correlation is always required. Special techniques can be employed in the application and analysis of ICU EEG monitoring. EEG has been useful in monitoring for ischemia, prognosis, and depth of medication-induced suppression. Quantitative EEG can also be utilized to assist in rapid seizure detection, and to monitor for subtle gradual changes in cerebral function and seizure detection. The special environment, however, requires close attention to technical considerations, and thoughtful interpretations of indeterminate patterns.

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