Clinical and intracranial electrophysiological signatures of post-operative and post-ictal delirium

IF 3.7 3区医学 Q1 CLINICAL NEUROLOGY

Clinical Neurophysiology Pub Date : 2025-01-20 DOI:10.1016/j.clinph.2024.12.023

Matthew I. Banks , Emily R. Dappen , Elie Matar , Benjamin D. Hayum , Michael H. Sutherland , Bryan M. Krause , Hiroto Kawasaki , Robert D. Sanders , Kirill V. Nourski

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引用次数: 0

Abstract

Objectives

(1) Gain insight into the mechanisms of postoperative delirium (POD). (2) Determine mechanistic overlap with post-ictal delirium (PID). Epilepsy patients undergoing intracranial electrophysiological monitoring can experience both POD and PID, and thus are suitable subjects for these investigations.

Methods

POD was assessed daily after surgery. PID was assessed following seizures. Resting state data were collected following delirium assessments, during a control period, and during sleep. Slow-wave activity (SWA: 1–4 Hz) and resting state functional connectivity were compared between different time points and according to delirium status.

Results

POD was present in 6 of 20 participants. Post-operatively, SWA was globally elevated in all participants but highest in POD+ participants. POD+ participants exhibited altered functional connectivity compared to POD-. These differences persisted even after resolution of delirium. PID was present in 7 of 15 participants and was predicted by seizures involving prefrontal cortex. PID+ participants exhibited higher post-ictal SWA versus PID-; no differences in functional connectivity were observed. Post-operative and post-ictal SWA was comparable to sleep in some participants.

Conclusions

Elevated SWA may predispose patients to both post-operative and post-ictal delirium and may indicate overlapping mechanisms.

Significance

Delirium treatments focused on SWA may be most effective for ameliorating cognitive symptoms.

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来源期刊

Clinical Neurophysiology 医学-临床神经学

CiteScore

8.70

自引率

6.40%

发文量

932

审稿时长

59 days

期刊介绍： As of January 1999, The journal Electroencephalography and Clinical Neurophysiology, and its two sections Electromyography and Motor Control and Evoked Potentials have amalgamated to become this journal - Clinical Neurophysiology. Clinical Neurophysiology is the official journal of the International Federation of Clinical Neurophysiology, the Brazilian Society of Clinical Neurophysiology, the Czech Society of Clinical Neurophysiology, the Italian Clinical Neurophysiology Society and the International Society of Intraoperative Neurophysiology.The journal is dedicated to fostering research and disseminating information on all aspects of both normal and abnormal functioning of the nervous system. The key aim of the publication is to disseminate scholarly reports on the pathophysiology underlying diseases of the central and peripheral nervous system of human patients. Clinical trials that use neurophysiological measures to document change are encouraged, as are manuscripts reporting data on integrated neuroimaging of central nervous function including, but not limited to, functional MRI, MEG, EEG, PET and other neuroimaging modalities.