scholarly journals Current and Future Uses of Continuous EEG in the NICU

2021 ◽  
Vol 9 ◽  
Author(s):  
Amanda G. Sandoval Karamian ◽  
Courtney J. Wusthoff
Keyword(s):  
Brain Activity ◽  
Response To Treatment ◽  
Limiting Factor ◽  
Neonatal Seizures ◽  
Clinical Factors ◽  
Gold Standard Method ◽  
Widespread Implementation ◽  
Continuous Eeg ◽  
Critically Ill Neonates ◽  
Clinical Conditions

Continuous EEG (cEEG) is a fundamental neurodiagnostic tool in the care of critically ill neonates and is increasingly recommended. cEEG enhances prognostication via assessment of the background brain activity, plays a role in predicting which neonates are at risk for seizures when combined with clinical factors, and allows for accurate diagnosis and management of neonatal seizures. Continuous EEG is the gold standard method for diagnosis of neonatal seizures and should be used for detection of seizures in high-risk clinical conditions, differential diagnosis of paroxysmal events, and assessment of response to treatment. High costs associated with cEEG are a limiting factor in its widespread implementation. Centralized remote cEEG interpretation, automated seizure detection, and pre-natal EEG are potential future applications of this neurodiagnostic tool.

scholarly journals Characterisation of neonatal seizures and their treatment using continuous EEG monitoring: a multicentre experience

2018 ◽  
Vol 104 (5) ◽  
pp. F493-F501 ◽  
Author(s):  
Janet M Rennie ◽  
Linda S de Vries ◽  
Mats Blennow ◽  
Adrienne Foran ◽  
Divyen K Shah ◽  
...  
Keyword(s):  
Genetic Disorders ◽  
Genetic Disorder ◽  
Median Number ◽  
Eeg Monitoring ◽  
Neonatal Seizures ◽  
Continuous Electroencephalography ◽  
Continuous Eeg ◽  
Continuous Eeg Monitoring ◽  
Electrographic Seizures ◽  
Median Maximum

ObjectiveThe aim of this multicentre study was to describe detailed characteristics of electrographic seizures in a cohort of neonates monitored with multichannel continuous electroencephalography (cEEG) in 6 European centres.MethodsNeonates of at least 36 weeks of gestation who required cEEG monitoring for clinical concerns were eligible, and were enrolled prospectively over 2 years from June 2013. Additional retrospective data were available from two centres for January 2011 to February 2014. Clinical data and EEGs were reviewed by expert neurophysiologists through a central server.ResultsOf 214 neonates who had recordings suitable for analysis, EEG seizures were confirmed in 75 (35%). The most common cause was hypoxic-ischaemic encephalopathy (44/75, 59%), followed by metabolic/genetic disorders (16/75, 21%) and stroke (10/75, 13%). The median number of seizures was 24 (IQR 9–51), and the median maximum hourly seizure burden in minutes per hour (MSB) was 21 min (IQR 11–32), with 21 (28%) having status epilepticus defined as MSB>30 min/hour. MSB developed later in neonates with a metabolic/genetic disorder. Over half (112/214, 52%) of the neonates were given at least one antiepileptic drug (AED) and both overtreatment and undertreatment was evident. When EEG monitoring was ongoing, 27 neonates (19%) with no electrographic seizures received AEDs. Fourteen neonates (19%) who did have electrographic seizures during cEEG monitoring did not receive an AED.ConclusionsOur results show that even with access to cEEG monitoring, neonatal seizures are frequent, difficult to recognise and difficult to treat.Oberservation study numberNCT02160171

scholarly journals Efficacy and economic evaluation of delivery of care with tele-continuous EEG in critically ill patients: a multicentre, randomised controlled trial (Tele-cRCT) study protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e033195
Author(s):  
Chusak Limotai ◽  
Atiporn Ingsathit ◽  
Kunlawat Thadanipon ◽  
Oraluck Pattanaprateep ◽  
Anuchate Pattanateepapon ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Cost Utility ◽  
Limiting Factor ◽  
Convulsive Status Epilepticus ◽  
Delivery Of Care ◽  
Continuous Eeg ◽  
Randomised Controlled

IntroductionSome critically ill patients are confirmed by continuous electroencephalography (cEEG) monitoring that non-convulsive seizure (NCS) and/or non-convulsive status epilepticus (NCSE) are causes of their depressed level of consciousness. Shortage of epilepsy specialists, especially in developing countries, is a major limiting factor in implementing cEEG in general practice. Delivery of care with tele-continous EEG (tele-cEEG) may be a potential solution as this allows specialists from a central facility to remotely assist local neurologists from distant areas in interpreting EEG findings and suggest proper treatment. No tele-cEEG programme has been implemented to help improve quality of care. Therefore, this study is conducted to assess the efficacy and cost utility of implementing tele-cEEG in critical care.Methods and analysisThe Tele-cRCT study is a 3-year prospective, randomised, controlled, parallel, multicentre, superiority trial comparing delivery of care through ‘Tele-cEEG’ intervention with ‘Tele-routine EEG (Tele-rEEG)’ in patients with clinical suspicion of NCS/NCSE. A group of EEG specialists and a tele-EEG system were set up to remotely interpret EEG findings in six regional government hospitals across Thailand. The primary outcomes are functional neurological outcome (modified Rankin Scale, mRS), mortality rate and incidence of seizures. The secondary outcomes are cost utility, length of stay, emergency visit/readmission, impact on changing medical decisions and health professionals’ perceptions about tele-cEEG implementation. Functional outcome (mRS) will be assessed at 3 and 7 days after recruitment, and again at time of hospital discharge, and at 90 days, 6 months, 9 months and 1 year. Costs and health-related quality of life will be assessed using the Thai version of the EuroQol-five dimensions-five levels (EQ-5D-5L) at hospital discharge, and at 90 days, 6 months, 9 months and 1 year.Ethics and disseminationThis study has been approved by the ethics committees of the Faculty of Medicine, Chulalongkorn University, and of Ramathibodi Hospital, Mahidol University, and registered on Thai Clinical Trials Registry. The results will be disseminated in a peer-reviewed journal.Trial registration numberTCTR20181022002; preresults.

A rare cause of acute kidney injury: hypothyroidism / Akut böbrek hasarının nadir bir nedeni: Hipotiroidizm

2016 ◽  
Vol 41 (4) ◽  
Author(s):  
Şimal Köksal Cevher ◽  
Ezgi Çoşkun Yenigün ◽  
Ramazan Öztürk ◽  
Fatih Dede
Keyword(s):  
Acute Kidney Injury ◽  
Case Reports ◽  
Hormone Replacement ◽  
Kidney Injury ◽  
Complete Response ◽  
Routine Clinical Practice ◽  
The Other ◽  
Response To Treatment ◽  
Electrolyte Disturbances ◽  
Clinical Conditions

AbstractKidneys and thyroid are two basic organs that interact with each other, and when one of them becomes ill, functions of the other are affected. Although electrolyte disturbances are the most common symptoms reported due to hypothyroidism, some are case reports in the literature suggested that acute kidney injury developed due to hypothyroidism. Despite this, we doubt that this information comes into mind in routine clinical practice. To report a case of reversible hypothyroidism-induced acute kidney injury, and review those two clinical conditions, which are often overlooked in the nephrology practice, in the light of the literature. We reported a 75-year-old female patient who admitted for acute kidney injury associated with deep hypothyroidism, required hemodialysis, and underwent a renal biopsy since no etiological factors were detected for acute kidney injury. We emphasized that the patient’s creatinine concentrations gradually returned to normal following hormone replacement therapy. Renal dysfunction in presence of hypothyroidism is a known, but frequently overlooked entity. Hypothyroidism should not be overlooked as the cause of reversible kidney injury since it is easy to treat, and there is almost complete response to treatment in terms of renal failure.

scholarly journals Similarity of brain activity patterns during learning and subsequent resting state predicts memory consolidation

2020 ◽  
Author(s):  
Z. Zavecz ◽  
K. Janacsek ◽  
P. Simor ◽  
M.X. Cohen ◽  
D. Nemeth
Keyword(s):  
Functional Connectivity ◽  
Memory Consolidation ◽  
Brain Activity ◽  
Serial Order ◽  
Order Information ◽  
Novel Approach ◽  
Continuous Eeg ◽  
Induced Changes ◽  
Probability Information ◽  
The Brain

AbstractLong-term memory depends on memory consolidation that seems to rely on learning-induced changes in the brain activity. Here, we introduced a novel approach analyzing continuous EEG data to study learning-induced changes as well as trait-like characteristics in brain activity underlying consolidation. Thirty-one healthy young adults performed a learning task and their performance was retested after a short (~1h) delay, that enabled us to investigate the consolidation of serial-order and probability information simultaneously. EEG was recorded during a pre- and post-learning rest period and during learning. To investigate the brain activity associated with consolidation performance, we quantified similarities in EEG functional connectivity of learning and pre-learning rest (baseline similarity) as well as learning and post-learning rest (post-learning similarity). While comparable patterns of these two could indicate trait-like similarities, changes in similarity from baseline to post-learning could indicate learning-induced changes, possibly spontaneous reactivation. Individuals with higher learning-induced changes in alpha frequency connectivity (8.5–9.5 Hz) showed better consolidation of serial-order information. This effect was stronger for more distant channels, highlighting the role of long-range centro-parietal networks underlying the consolidation of serial-order information. The consolidation of probability information was associated with learning-induced changes in delta frequency connectivity (2.5–3 Hz) and seemed to be dependent on more local, short-range connections. Beyond these associations with learning-induced changes, we also found substantial overlap between the baseline and post-learning similarity and their associations with consolidation performance, indicating that stable (trait-like) differences in functional connectivity networks may also be crucial for memory consolidation.Significance statementWe studied memory consolidation in humans by characterizing how similarity in neural oscillatory patterns during learning and rest periods supports consolidation. Previous studies on similarity focused on learning-induced changes (including reactivation) and neglected the stable individual characteristics that are present over resting periods and learning. Moreover, learning-induced changes are predominantly studied invasively in rodents or with neuroimaging or event-related electrophysiology techniques in humans. Here, we introduced a novel approach that enabled us 1) to reveal both learning-induced changes and trait-like individual differences in brain activity and 2) to study learning-induced changes in humans by analyzing continuous EEG. We investigated the consolidation of two types of information and revealed distinct learning-induced changes and trait-like characteristics underlying the different memory processes.

scholarly journals Predictors of favorable response to implanted of ventriculoperitoneal shunt in patients with idiopathic normal pressure hydrocephalus

2020 ◽  
Vol 1 (1) ◽  
pp. 81-86
Author(s):  
Mario Emiliano Ricciardi ◽  
Ismael Calandri ◽  
Lucas Alessandro ◽  
Mauricio Farez ◽  
Juan Villalonga ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Retrospective Study ◽  
Normal Pressure Hydrocephalus ◽  
Ventriculoperitoneal Shunt ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Response To Treatment ◽  
Clinical Factors ◽  
A Prospective Study

Introduction: The indication of a ventriculoperitoneal shunt (VPS) is discussed in patients with idiopathic normal pressure hydrocephalus (iNPH), due to the heterogeneity of the response to treatment and the risks involved in neurosurgery. Objective: To search for clinical factors and complementary studies in order to determine predictors of a favorable response to the VPS placement in patients with iNPH. Methodology: A retrospective study of patients with probable iNPH (according to international guidelines) treated with VPS assisted in a neurological clinic from January 2014 to January 2017 was conducted. A univariate statisticalanalysis of the variables considered as possible prognostic factors was performed. Results: 58 patients were included. Women presented 3.68 times more chances of improvement after the VPS (p=0.019). Good response to the gait test was associated with better response to the VPS (p=0.024). Conclusions: Female sex and good response to the gait test could be considered as predictors of a favorable response to the VPS placement in patients with iNPH. A prospective study is necessary to achieve a homogeneous diagnostic evaluation and a more extensive longitudinal follow-up to evaluate the clinical evolution in this group of patients.

scholarly journals Electroencephalography-based monitors

2015 ◽  
Vol 02 (03) ◽  
pp. 168-178 ◽  
Author(s):  
Nidhi Gupta ◽  
Gyaninder Singh
Keyword(s):  
Quantitative Eeg ◽  
Convulsive Status Epilepticus ◽  
Technological Advancement ◽  
Depth Of Anaesthesia ◽  
Barbiturate Coma ◽  
Clinical Applicability ◽  
Continuous Eeg ◽  
Alteration Of Consciousness ◽  
Clinical Conditions ◽  
Electroencephalogram Eeg

AbstractAn electroencephalogram (EEG), detects changes and abnormalities in the electrical activity of the brain and thus provides a way to dynamically assess brain function. EEG may be used to diagnose and manage a number of clinical conditions such as epilepsy, convulsive and non-convulsive status epilepticus, encephalitis, barbiturate coma, brain death, etc., EEG provides a large amount of information to the anaesthesiologist for routine clinical practice as depth of anaesthesia monitors and detection of sub-clinical seizures; and also for understanding the complex mechanisms of anaesthesia-induced alteration of consciousness. In the initial years, the routine clinical applicability of EEG was hindered by the complexity of the raw EEG signal. However, with technological advancement, several EEG-derived dimensionless indices have been developed that correlate with the depth of the hypnotic component of anaesthesia and are easy to interpret. Similarly, with the development of quantitative EEG tools, the routine use of continuous EEG is ever expanding in the Intensive Care Units. This review, describe various commonly used EEG-based monitors and their clinical applicability in the field of anaesthesia and critical care.

Effect of reconstituted glutathione preparations on bioelectric brain activity in severe ethanol poisoning

2020 ◽  
pp. 18-24
Author(s):  
M. V. Aleksandrov ◽  
T. V. Aleksandrova ◽  
V. S. Chernyi1 ◽  
M. A. Lucyk
Keyword(s):  
Alcohol Intoxication ◽  
Brain Activity ◽  
Epileptiform Activity ◽  
Basic Therapy ◽  
The Awakening ◽  
Continuous Eeg ◽  
Continuous Eeg Monitoring ◽  
Ethanol Poisoning ◽  
Time Of Admission

Fifty patients with acute severe ethanol poisoning (depression of consciousness at the time of admission was up to the level of coma) were examined. Based on the purpose of the study, patients were divided into two groups. In the first group, basic etiopathogenetic therapy was supplemented by the intravenous administration of a drug based on reduced glutathione: inosine glycyl-cysteinyl-glutamate disodium (IGCGD). In the second group, only basic therapy was performed. All patients underwent in the intensive care long-term continuous EEG monitoring, which was started at the end of basic resuscitation and stopped when the patient was clearly awake. Based on the nature of spontaneous EEG and reactivity, patients were divided into subgroups: patients with theta coma pattern and patients with delta coma pattern.It was found that the introduction of IGCGD in the treatment of severe ethanol poisoning in the group of patients with a reactive delta pattern significantly increased the rate of formation of awakening in the EEG: in the subgroup with basic therapy, the formation time of the awakening pattern was about 3 hours, and in the subgroup of patients to whom the drug was administered 1,5 hours. In the group of patients with depression of EEG to the level of theta coma, IGCGD had no effect on the time of formation of the EEG pattern of awakening. The inclusion of inosine IGCGD in the treatment of severe alcohol intoxication was not accompanied by more frequent formation of epileptiform activity in the EEG.

scholarly journals Leptin Therapy Alters Appetite and Neural Responses to Food Stimuli in Brain Areas of Leptin-Sensitive Subjects Without Altering Brain Structure

2014 ◽  
Vol 99 (12) ◽  
pp. E2529-E2538 ◽  
Author(s):  
Olivia M. Farr ◽  
Christina Fiorenza ◽  
Panagiotis Papageorgiou ◽  
Mary Brinkoetter ◽  
Florencia Ziemke ◽  
...  
Keyword(s):  
Brain Structure ◽  
Structural Changes ◽  
Medical Center ◽  
Brain Activity ◽  
Academic Medical Center ◽  
Reward Processing ◽  
Response To Treatment ◽  
Leptin Deficiency ◽  
Long Term Treatment

Context: Leptin is a key regulator of energy intake and expenditure. Individuals with congenital leptin deficiency demonstrate structural and functional brain changes when given leptin. However, whether acquired leptin deficiency may operate similarly is unclear. Objective: We set out to determine whether the brains of individuals with acquired leptin deficiency may react to leptin in a similar manner. Design: We used functional magnetic resonance imaging before and after short- and long-term metreleptin treatment in three leptin-sensitive patients with acquired hypoleptinemia. Nine healthy women were scanned as normoleptinemic controls. Setting: The setting was an academic medical center. Patients or Other Participants: The participants were 3 hypoleptinemic women and nine normoleptinemic, matched women. Interventions: We used metreleptin, recombinant leptin, therapy for 24 weeks in hypoleptinemic women only. Main Outcome Measure: We measured neural changes in response to viewing food as compared to nonfood images. We hypothesized that metreleptin treatment would increase brain activity in areas related to cognitive control and inhibition and would decrease brain activity in areas related to reward processing, as compared to the normoleptinemic counterparts. Results: Unlike patients with congenital leptin deficiency, hypoleptinemic patients demonstrated no structural brain differences from healthy controls and/or structural changes in response to treatment. Short-term metreleptin treatment in leptin-sensitive hypoleptinemic subjects enhances areas involved in detecting the salience and rewarding value of food during fasting, whereas long-term treatment decreases attention to food and the rewarding value of food after feeding. Furthermore, hypothalamic activity is modulated by metreleptin treatment, and leptin decreases functional connectivity of the hypothalamus to key feeding-related areas in these hypoleptinemic subjects. Conclusions: Leptin replacement in acutely hypoleptinemic women did not alter brain structure but did alter functional cortical activity to food cues in key feeding and reward-related areas.

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