Sensitivity of a Reduced EEG Montage for Seizure Detection in the Neurocritical Care Setting

AbstractFever is considered a protective response having multitude of benefits in terms of enhancing resistance to infection, recruiting cytokines to the injured tissue, and promoting healing. In terms of an injured brain, this becomes a double-edged sword triggering an inflammatory cascade resulting in secondary brain injury. It is important to identify the etiology so that corrective measures can be taken. Here we report a case of persistent fever in a patient with Guillain-Barré syndrome, which was probably due to heparin. This is the first report of heparin-induced fever in a neurocritical care setting and third report overall.

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S18-1. Electroencephalography (EEG) in the neurocritical care setting

Clinical Neurophysiology ◽

10.1016/j.clinph.2019.06.143 ◽

2019 ◽

Vol 130 (10) ◽

pp. e204

Author(s):

Yuichi Kubota

Keyword(s):

Care Setting ◽

Neurocritical Care

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Multimodal nocturnal seizure detection in a residential care setting

Neurology ◽

10.1212/wnl.0000000000006545 ◽

2018 ◽

Vol 91 (21) ◽

pp. e2010-e2019 ◽

Cited By ~ 20

Author(s):

Johan Arends ◽

Roland D. Thijs ◽

Thea Gutter ◽

Constantin Ungureanu ◽

Pierre Cluitmans ◽

...

Keyword(s):

Heart Rate ◽

Care Setting ◽

Interobserver Agreement ◽

False Negative ◽

Seizure Detection ◽

Device Performance ◽

Upper Arm ◽

Reliable Detection ◽

Residential Care Setting ◽

Nocturnal Seizures

ObjectiveTo develop and prospectively evaluate a method of epileptic seizure detection combining heart rate and movement.MethodsIn this multicenter, in-home, prospective, video-controlled cohort study, nocturnal seizures were detected by heart rate (photoplethysmography) or movement (3-D accelerometry) in persons with epilepsy and intellectual disability. Participants with >1 monthly major seizure wore a bracelet (Nightwatch) on the upper arm at night for 2 to 3 months. Major seizures were tonic-clonic, generalized tonic >30 seconds, hyperkinetic, or others, including clusters (>30 minutes) of short myoclonic/tonic seizures. The video of all events (alarms, nurse diaries) and 10% completely screened nights were reviewed to classify major (needing an alarm), minor (needing no alarm), or no seizure. Reliability was tested by interobserver agreement. We determined device performance, compared it to a bed sensor (Emfit), and evaluated the caregivers’ user experience.ResultsTwenty-eight of 34 admitted participants (1,826 nights, 809 major seizures) completed the study. Interobserver agreement (major/no major seizures) was 0.77 (95% confidence interval [CI] 0.65–0.89). Median sensitivity per participant amounted to 86% (95% CI 77%–93%); the false-negative alarm rate was 0.03 per night (95% CI 0.01–0.05); and the positive predictive value was 49% (95% CI 33%–64%). The multimodal sensor showed a better sensitivity than the bed sensor (n = 14, median difference 58%, 95% CI 39%–80%, p < 0.001). The caregivers' questionnaire (n = 33) indicated good sensor acceptance and usability according to 28 and 27 participants, respectively.ConclusionCombining heart rate and movement resulted in reliable detection of a broad range of nocturnal seizures.

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Implementation of a Neurocritical Care Program: Improved Seizure Detection and Decreased Antiseizure Medication at Discharge in Neonates With Hypoxic-Ischemic Encephalopathy

Pediatric Neurology ◽

10.1016/j.pediatrneurol.2016.07.007 ◽

2016 ◽

Vol 64 ◽

pp. 38-43 ◽

Cited By ~ 16

Author(s):

Rani Ameena Bashir ◽

Liza Espinoza ◽

Sakeer Vayalthrikkovil ◽

Jeffrey Buchhalter ◽

Leigh Irvine ◽

...

Keyword(s):

Neurocritical Care ◽

Care Program ◽

Seizure Detection ◽

Hypoxic Ischemic Encephalopathy ◽

Ischemic Encephalopathy

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Music in mechanically ventilated stroke patients

British Journal of Neuroscience Nursing ◽

10.12968/bjnn.2019.15.sup5.s8 ◽

2019 ◽

Vol 15 (Sup5) ◽

pp. S8-S13

Author(s):

DaiWai M Olson ◽

Anjali Perera ◽

Folefac Atem ◽

Audra S Wagner ◽

Michael Zanders ◽

...

Keyword(s):

Critical Care ◽

Pilot Study ◽

Stress Reduction ◽

Care Setting ◽

Neurocritical Care ◽

Stroke Patients ◽

Mechanically Ventilated ◽

Significant Difference ◽

Pilot Intervention ◽

Route Of Delivery

Background: Music as a therapeutic intervention for critically ill stroke patients has not been adequately researched. This may be related to a limited number of tools being available to measure the hypnotic response when patients cannot respond verbally. This pilot study examines the feasibility of bispectral index (BIS) monitoring to study music as a stress-reduction intervention in the neurocritical care setting. Methods: This prospective, randomised, crossover, pilot study enrolled 30 patients. On each of two consecutive days, patients were randomised to either 1 hour of silence followed by a crossover to 1 hour of music, or the reverse (music then silence). BIS values were recorded to evaluate stress and agitation before, during and after the 2-hour study period. Results: There were no reported adverse events, supporting feasibility of this pilot intervention. BIS values were sampled once every 6 seconds during the 2-hour study period. There was a statistically significant difference in BIS scores between the music and no music group (p<0.0001). Conclusion: The use of neurofunction monitors to assess response to music is feasible during the critical care phase for patients with stroke. Additional studies should focus on genre, timing and route of delivery for music as an intervention.

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Intracranial hypotension masquerading as nonconvulsive status epilepticus

Journal of Neurosurgery ◽

10.3171/2013.7.jns112308 ◽

2014 ◽

Vol 120 (3) ◽

pp. 624-627 ◽

Cited By ~ 5

Author(s):

Vishnumurthy Shushrutha Hedna ◽

Abhay Kumar ◽

Bayard Miller ◽

Sharathchandra Bidari ◽

Arash Salardini ◽

...

Keyword(s):

Status Epilepticus ◽

Intracranial Hypotension ◽

Care Setting ◽

Neurocritical Care ◽

Clinical Status ◽

Subsequent Treatment ◽

Nonconvulsive Status Epilepticus ◽

Metabolic Dysfunction ◽

Csf Pressure ◽

Orthostatic Symptoms

Intracranial hypotension (IH) has been a known entity in neurocritical care since 1938. Even though many cases are spontaneous, the incidence of intracranial hypotension in the neurocritical care setting is increasing by virtue of the increased number of neurosurgical interventions. Whether spontaneous or secondary in etiology, diagnosis of IH usually requires the presence of orthostatic symptoms, including headaches and nausea with low opening CSF pressure. However, typical clinical features in the appropriate clinical context and imaging, even with normal CSF pressure, can indicate IH. In the neurocritical care setting, challenges for accurate semiology include altered sensorium and reduced levels of responsiveness for which many etiologies may exist, including metabolic dysfunction, traumatic brain injury, IH, or nonconvulsive status epilepticus (NCSE). The authors describe 3 patients whose clinical picture and electroencephalography (EEG) findings initially suggested NCSE but who did not respond to treatment with antiepileptic drugs alone. Neuroimaging suggested IH, and subsequent treatment of IH successfully improved the patient's clinical status. To the authors' knowledge this paper is the first in the literature that reports a correlation of IH with electrographic findings similar to NCSE as cause and effect. The authors' hypothesis is that thalamocortical dysfunction causes EEG findings that appear to be similar to those in NCSE but that these conditions do not coexist. The EEG activity is not epileptogenic, and IH results in blocking network pathways producing thalamocortical dysfunction. The authors discuss the hypothesis and pathophysiology of these epileptiform changes in relation to IH.

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