{"title":"Effect of Sevoflurane Anesthesia on Intraoperative Spikes, High-Frequency Oscillations, and Phase-Amplitude Coupling in MRI-Normal Hippocampus.","authors":"Riju Dahal, Kentaro Tamura, Dong-Sheng Pan, Ryota Sasaki, Yasuhiro Takeshima, Ryosuke Matsuda, Shuichi Yamada, Fumihiko Nishimura, Ichiro Nakagawa, Young-Soo Park, Hironobu Hayashi, Masahiko Kawaguchi, Hiroyuki Nakase","doi":"10.1097/WNP.0000000000001031","DOIUrl":"10.1097/WNP.0000000000001031","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to determine the effect of sevoflurane anesthesia on spikes, high-frequency oscillations (HFOs), and phase-amplitude coupling using a modulation index in MRI-normal hippocampus, with the aim of evaluating the utility of intraoperative electrocorticography in identifying the epileptogenic hippocampus during sevoflurane administration.</p><p><strong>Methods: </strong>Eleven patients with intractable temporal lobe epilepsy with a normal hippocampus on MRI underwent extra-operative electrocorticography evaluation. Patients were assigned to the Ictal (+) or Ictal (-) group depending on whether the parahippocampal gyrus was included in the seizure onset zone. Intraoperative electrocorticography was performed under 0.5 and 1.5 minimum alveolar concentration of sevoflurane. The rates of spikes, ripples, fast ripples (FRs), ripples on spikes, FRs on spikes, and MI HFO(3-4 Hz) were evaluated.</p><p><strong>Results: </strong>During the intraoperative electrocorticography procedure, sevoflurane administration was found to significantly increase the rate of spikes, ripples on spikes, fast ripples on spikes, and MI HFO(3-4 Hz) in the Ictal (+) group ( P < 0.01). By contrast, the Ictal (-) group exhibited a paradoxical increase in the rate of ripples and fast ripple ( P < 0.05).</p><p><strong>Conclusions: </strong>Our findings indicate that the administration of sevoflurane during intraoperative electrocorticography in patients with MRI-normal hippocampus can lead to a dose-dependent enhancement of epileptic biomarkers (spikes, ripples on spikes, fast ripples on spikes, and MI (HFO 3-4) ) in the epileptogenic hippocampus, while paradoxically increasing the rate of ripples and fast ripple in the nonepileptogenic hippocampus. These results have significant implications for the identification of the MRI-normal hippocampus that requires surgical intervention and preservation of the nonepileptogenic hippocampus.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"589-596"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71482165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bernhard J Steinhoff, Tassanai Intravooth, Jitender Gupta, Viviane Bernedo-Paredes, Patricia Mahn, Jakob Stockinger, Peter Martin, Anke M Staack
{"title":"Diagnostic Value of Intermittent Photic Stimulation Among Adult Patients in a Tertiary Referral Epilepsy Center: A Retrospective Study.","authors":"Bernhard J Steinhoff, Tassanai Intravooth, Jitender Gupta, Viviane Bernedo-Paredes, Patricia Mahn, Jakob Stockinger, Peter Martin, Anke M Staack","doi":"10.1097/WNP.0000000000001040","DOIUrl":"10.1097/WNP.0000000000001040","url":null,"abstract":"<p><strong>Purpose: </strong>Photosensitivity is a phenomenon that may be elicited by standardized intermittent photic stimulation during EEG recording and is detected more frequently in children and adolescents. Nevertheless, at our Epilepsy Center, we routinely assess photosensitivity in all newly referred adult patients. In this investigation, we sought to address the diagnostic yield under the prerequisites described.</p><p><strong>Methods: </strong>We reanalyzed all routine EEG recordings among referrals to the department of adults during the first six months of 2019, including a simultaneous video that is always coregistered in our center. The prevalence of abnormal findings during photic stimulation was assessed.</p><p><strong>Results: </strong>Intermittent photic stimulation was performed on 344 patients. Photoparoxysmal response were detected in five subjects (1.5%). All patients were female. Four patients were diagnosed with idiopathic generalized epilepsy, and one with Doose syndrome. Photomyogenic responses were recorded in 1.1% and only in patients with psychogenic nonepileptic seizures. In two subjects with psychogenic nonepileptic seizures, the typical seizure was provoked by intermittent photic stimulation (8.7% of all subjects with psychogenic nonepileptic seizures in this cohort). Photoparoxysmal response was not detected in any subject with focal epilepsy, syncope, or other nonepileptic paroxysmal events. In every case of photoparoxysmal responses, increased photosensitivity had already been reported before recording.</p><p><strong>Conclusions: </strong>In our study, photoparoxysmal responses was a rare phenomenon among adults with a preponderance of females and idiopathic generalized epilepsies. Intermittent photic stimulation may be helpful in provoking typical psychogenic nonepileptic seizures and thus abbreviate the diagnostic process. Provided a careful history, routine intermittent photic stimulation in adults with epilepsy does not appear to be mandatory.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"625-629"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41134192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michael P Skolka, Reece M Hass, Devon I Rubin, Ruple S Laughlin
{"title":"Association of Complex Repetitive Discharges With Chronicity and Clinical Symptoms in Radiculopathies.","authors":"Michael P Skolka, Reece M Hass, Devon I Rubin, Ruple S Laughlin","doi":"10.1097/WNP.0000000000001036","DOIUrl":"10.1097/WNP.0000000000001036","url":null,"abstract":"<p><strong>Purpose: </strong>Complex repetitive discharges (CRDs) are incompletely understood needle electromyography (EMG) waveforms seen in both myopathic and neurogenic disorders including radiculopathies. This study aimed to clarify the significance of CRDs in patients with radiculopathies.</p><p><strong>Methods: </strong>This case-control study randomly identified 100 patients with needle EMG evidence of radiculopathy demonstrating at least one CRD in the electrodiagnostically involved myotome between January 2017 and January 2022. These patients were compared with 100 randomly selected patients with EMG evidence of radiculopathy without CRDs controlled for sex, age at EMG testing, and affected nerve root segment. Patient clinical symptoms, neurologic examination, EMG features, and imaging were analyzed. A paired sample t -test for categorial data and χ 2 test for nonparametric data were used for statistical analysis with significance defined as P < 0.05.</p><p><strong>Results: </strong>Patients with radiculopathies with CRDs had longer disease duration averaging 59 months (range 1-480) compared with patients with radiculopathies without CRDs averaging 26 months (range 1-192, P < 0.01). Clinical symptoms of paresthesias and weakness were both significantly more common in patients with radiculopathies with CRDs than those without CRDs ( P < 0.01 and 0.01, respectively). Needle EMG demonstrated a greater average number of muscles with neurogenic motor unit potentials per radiculopathy in patients with radiculopathies with CRDs compared with those without CRDs. Imaging studies of patients with radiculopathies with CRDs were more likely to reveal evidence of nerve root compression ( P < 0.01).</p><p><strong>Conclusions: </strong>The presence of CRDs in patients with radiculopathies is consistent with clinically more symptomatic radiculopathies and a longer duration of nerve root compromise.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"606-609"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41202404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Comparison of Automated Spike Detection Software in Detecting Epileptiform Abnormalities on Scalp-EEG of Genetic Generalized Epilepsy Patients.","authors":"Mubeen Janmohamed, Duong Nhu, Lubna Shakathreh, Ofer Gonen, Levin Kuhlman, Amanda Gilligan, Chang Wei Tan, Piero Perucca, Terence J O'Brien, Patrick Kwan","doi":"10.1097/WNP.0000000000001039","DOIUrl":"10.1097/WNP.0000000000001039","url":null,"abstract":"<p><strong>Purpose: </strong>Despite availability of commercial EEG software for automated epileptiform detection, validation on real-world EEG datasets is lacking. Performance evaluation of two software packages on a large EEG dataset of patients with genetic generalized epilepsy was performed.</p><p><strong>Methods: </strong>Three epileptologists labelled IEDs manually of EEGs from three centres. All Interictal epileptiform discharge (IED) markings predicted by two commercial software (Encevis 1.11 and Persyst 14) were reviewed individually to assess for suspicious missed markings and were integrated into the reference standard if overlooked during manual annotation during a second phase. Sensitivity, precision, specificity, and F1-score were used to assess the performance of the software packages against the adjusted reference standard.</p><p><strong>Results: </strong>One hundred and twenty-five routine scalp EEG recordings from different subjects were included (total recording time, 310.7 hours). The total epileptiform discharge reference count was 5,907 (including spikes and fragments). Encevis demonstrated a mean sensitivity for detection of IEDs of 0.46 (SD 0.32), mean precision of 0.37 (SD 0.31), and mean F1-score of 0.43 (SD 0.23). Using the default medium setting, the sensitivity of Persyst was 0.67 (SD 0.31), with a precision of 0.49 (SD 0.33) and F1-score of 0.51 (SD 0.25). Mean specificity representing non-IED window identification and classification was 0.973 (SD 0.08) for Encevis and 0.968 (SD 0.07) for Persyst.</p><p><strong>Conclusions: </strong>Automated software shows a high degree of specificity for detection of nonepileptiform background. Sensitivity and precision for IED detection is lower, but may be acceptable for initial screening in the clinical and research setting. Clinical caution and continuous expert human oversight are recommended with all EEG recordings before a diagnostic interpretation is provided based on the output of the software.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"618-624"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71482163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jaeho Hwang, Sung-Min Cho, Romergryko Geocadin, Eva K Ritzl
{"title":"Methods of Evaluating EEG Reactivity in Adult Intensive Care Units: A Review.","authors":"Jaeho Hwang, Sung-Min Cho, Romergryko Geocadin, Eva K Ritzl","doi":"10.1097/WNP.0000000000001078","DOIUrl":"10.1097/WNP.0000000000001078","url":null,"abstract":"<p><strong>Purpose: </strong>EEG reactivity (EEG-R) has become widely used in intensive care units for diagnosing and prognosticating patients with disorders of consciousness. Despite efforts toward standardization, including the establishment of terminology for critical care EEG in 2012, the processes of testing and interpreting EEG-R remain inconsistent.</p><p><strong>Methods: </strong>A review was conducted on PubMed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria consisted of articles published between January 2012, and November 2022, testing EEG-R on adult intensive care unit patients. Exclusion criteria included articles focused on highly specialized stimulation equipment or animal, basic science, or small case report studies. The Quality In Prognostic Studies tool was used to assess risk of bias.</p><p><strong>Results: </strong>One hundred and five articles were identified, with 26 variables collected for each. EEG-R testing varied greatly, including the number of stimuli (range: 1-8; 26 total described), stimulus length (range: 2-30 seconds), length between stimuli (range: 10 seconds-5 minutes), frequency of stimulus application (range: 1-9), frequency of EEG-R testing (range: 1-3 times daily), EEG electrodes (range: 4-64), personnel testing EEG-R (range: neurophysiologists to nonexperts), and sedation protocols (range: discontinuing all sedation to no attempt). EEG-R interpretation widely varied, including EEG-R definitions and grading scales, personnel interpreting EEG-R (range: EEG specialists to nonneurologists), use of quantitative methods, EEG filters, and time to detect EEG-R poststimulation (range: 1-30 seconds).</p><p><strong>Conclusions: </strong>This study demonstrates the persistent heterogeneity of testing and interpreting EEG-R over the past decade, and contributing components were identified. Further many institutional efforts must be made toward standardization, focusing on the reproducibility and unification of these methods, and detailed documentation in the published literature.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"577-588"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141300783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Neerrajah Nadarajah, Michael Fahey, Udaya Seneviratne
{"title":"Does Hyperventilation Increase the Diagnostic Yield of the Routine Electroencephalogram: A Retrospective Analysis of Adult and Pediatric Cohorts.","authors":"Neerrajah Nadarajah, Michael Fahey, Udaya Seneviratne","doi":"10.1097/WNP.0000000000001066","DOIUrl":"10.1097/WNP.0000000000001066","url":null,"abstract":"<p><strong>Purpose: </strong>While hyperventilation (HV) increases the diagnostic yield of EEG in children, there is conflicting evidence to support its application in adults. For the first time in history, a large cohort of patients has undergone EEGs without HV during the COVID-19 pandemic. Utilizing this opportunity, we sought to investigate whether HV increases the diagnostic yield of EEG in children compared with adults.</p><p><strong>Methods: </strong>Patients aged six years and above who had routine EEGs at Monash Health between January 2019 and December 2020 were studied. The cohort was divided into two, pediatric (younger than 18 years) and adult (18 years or older). Epileptiform abnormalities (ictal and interictal) were the outcomes investigated. The effect of HV was examined with logistic regression to determine odds ratios with 95% confidence intervals.</p><p><strong>Results: </strong>In total, we studied 3,273 patients (pediatric = 830, adult = 2,443). In the pediatric cohort, HV significantly increased the diagnostic yield of absence seizures ( p = 0.01, odds ratios 2.44, 95% confidence intervals 1.21-4.93). In adults, HV did not increase the yield of absence seizures ( p = 0.34, odds ratios 0.36, 95% confidence intervals 0.05-2.88). Interictal epileptiform discharges during HV were significantly more frequent in children compared with adults ( p < 0.001, odds ratios 3.81, 95% confidence intervals 2.51-5.77).</p><p><strong>Conclusions: </strong>Hyperventilation is useful to increase the yield of interictal epileptiform discharges and absence seizures in pediatric patients but not in adults. Hence, routine EEG may be recorded in adults without HV when it is unsafe to perform.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"640-651"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141446286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mario Garingo, Chaim Katz, Kramay Patel, Stephan Meyer Zum Alten Borgloh, Parisa Sabetian, Jeffrey Durmer, Sharon Chiang, Vikram R Rao, John M Stern
{"title":"Four State Sleep Staging From a Multilayered Algorithm Using Electrocardiographic and Actigraphic Data.","authors":"Mario Garingo, Chaim Katz, Kramay Patel, Stephan Meyer Zum Alten Borgloh, Parisa Sabetian, Jeffrey Durmer, Sharon Chiang, Vikram R Rao, John M Stern","doi":"10.1097/WNP.0000000000001038","DOIUrl":"10.1097/WNP.0000000000001038","url":null,"abstract":"<p><strong>Purpose: </strong>Sleep studies are important to evaluate sleep and sleep-related disorders. The standard test for evaluating sleep is polysomnography, during which several physiological signals are recorded separately and simultaneously with specialized equipment that requires a technologist. Simpler recordings that can model the results of a polysomnography would provide the benefit of expanding the possibilities of sleep recordings.</p><p><strong>Methods: </strong>Using the publicly available sleep data set from the multiethnic study of atherosclerosis and 1769 nights of sleep, we extracted a distinct data subset with engineered features of the biomarkers collected by actigraphic, oxygenation, and electrocardiographic sensors. We then applied scalable models with recurrent neural network and Extreme Gradient Boosting (XGBoost) with a layered approach to produce an algorithm that we then validated with a separate data set of 177 nights.</p><p><strong>Results: </strong>The algorithm achieved an overall performance of 0.833 accuracy and 0.736 kappa in classifying into four states: wake, light sleep, deep sleep, and rapid eye movement (REM). Using feature analysis, we demonstrated that heart rate variability is the most salient feature, which is similar to prior reports.</p><p><strong>Conclusions: </strong>Our results demonstrate the potential benefit of a multilayered algorithm and achieved higher accuracy and kappa than previously described approaches for staging sleep. The results further the possibility of simple, wearable devices for sleep staging. Code is available at https://github.com/NovelaNeuro/nEureka-SleepStaging .</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"610-617"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11186678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41131850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Corticothalamic Responsive Neurostimulation for Focal Epilepsy: A Single-Center Experience.","authors":"David Burdette, Sanjay Patra, Lise Johnson","doi":"10.1097/WNP.0000000000001060","DOIUrl":"10.1097/WNP.0000000000001060","url":null,"abstract":"<p><strong>Purpose: </strong>Owing to its extensive, reciprocal connectivity with the cortex and other subcortical structures, the thalamus is considered an important target for neuromodulation in drug-resistant focal epilepsy. Using corticothalamic stimulation, it is possible to modulate both the thalamus and the cortical seizure onset zone. Limited published clinical experience describes corticothalamic stimulation with depth leads targeting one of the anterior (ANT), centromedian (centromedian nucleus), or pulvinar (PUL) thalamic nuclei. However, it is not clear which of these nuclei is the \"best\" therapeutic target.</p><p><strong>Methods: </strong>This study comprised a single-center experience with corticothalamic responsive neurostimulation using the RNS System to target these three thalamic nuclei. Presented here are the methods for target selection and device programming as well as clinical outcomes and a comparison of ictal and nonictal electrophysiological features.</p><p><strong>Results: </strong>In this small retrospective study ( N = 19), responsive corticothalamic neurostimulation was an effective therapy for 79% of patients (≥50% reduction in disabling seizure frequency), regardless of whether the thalamic lead was implanted in the ANT ( N = 2), PUL ( N = 6), or centromedian nucleus ( N = 11). Twenty-six percent of patients reported a reduction in disabling seizure frequency ≥90%. Both high frequency (≥100 Hz) and low (≤20 Hz) frequency were used to stimulate the thalamus depending on the patient's response and ability to tolerate higher charge densities. In all patients, a longer burst duration (2000-5000 ms) was ultimately implemented on the thalamic leads. Across patients, peaks in the intracranial EEG were observed at theta, beta, gamma, and sleep spindle frequencies. Changes in frequency content and distribution were observed over time in all three nuclei.</p><p><strong>Conclusions: </strong>These results indicate that both high frequency and low frequency corticothalamic responsive neurostimulation can potentially be an effective adjunctive therapy in drug-resistant focal epilepsy. These data can also contribute to a broader understanding of thalamic electrophysiology in the context of focal epilepsy.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"630-639"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11520339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139403121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Imad R Khan, Irfaan A Dar, Thomas W Johnson, Emily Loose, Yama Y Xu, Esmeralda Santiago, Kelly L Donohue, Mark A Marinescu, Igor Gosev, Giovanni Schifitto, Ross K Maddox, David R Busch, Regine Choe, Olga Selioutski
{"title":"Correlations Between Quantitative EEG Parameters and Cortical Blood Flow in Patients Undergoing Extracorporeal Membrane Oxygenation With and Without Encephalopathy.","authors":"Imad R Khan, Irfaan A Dar, Thomas W Johnson, Emily Loose, Yama Y Xu, Esmeralda Santiago, Kelly L Donohue, Mark A Marinescu, Igor Gosev, Giovanni Schifitto, Ross K Maddox, David R Busch, Regine Choe, Olga Selioutski","doi":"10.1097/WNP.0000000000001035","DOIUrl":"10.1097/WNP.0000000000001035","url":null,"abstract":"<p><strong>Purpose: </strong>The neurologic examination of patients undergoing extracorporeal membrane oxygenation (ECMO) is crucial for evaluating irreversible encephalopathy but is often obscured by sedation or neuromuscular blockade. Noninvasive neuromonitoring modalities including diffuse correlation spectroscopy and EEG measure cerebral perfusion and neuronal function, respectively. We hypothesized that encephalopathic ECMO patients with greater degree of irreversible cerebral injury demonstrate less correlation between electrographic activity and cerebral perfusion than those whose encephalopathy is attributable to medications.</p><p><strong>Methods: </strong>We performed a prospective observational study of adults undergoing ECMO who underwent simultaneous continuous EEG and diffuse correlation spectroscopy monitoring. (Alpha + beta)/delta ratio and alpha/delta Rartio derived from quantitative EEG analysis were correlated with frontal cortical blood flow index. Patients who awakened and followed commands during sedation pauses were included in group 1, whereas patients who could not follow commands for most neuromonitoring were placed in group 2. (Alpha + beta)/delta ratio-blood flow index and ADR-BFI correlations were compared between the groups.</p><p><strong>Results: </strong>Ten patients (five in each group) underwent 39 concomitant continuous EEG and diffuse correlation spectroscopy monitoring sessions. Four patients (80%) in each group received some form of analgosedation during neuromonitoring. (Alpha + beta)/delta ratio-blood flow index correlation was significantly lower in group 2 than group 1 (left: 0.05 vs. 0.52, P = 0.03; right: -0.12 vs. 0.39, P = 0.04). Group 2 ADR-BFI correlation was lower only over the right hemisphere (-0.06 vs. 0.47, P = 0.04).</p><p><strong>Conclusions: </strong>Correlation between (alpha + beta)/delta ratio and blood flow index were decreased in encephalopathic ECMO patients compared with awake ones, regardless of the analgosedation use. The combined use of EEG and diffuse correlation spectroscopy may have utility in monitoring cerebral function in ECMO patients.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"597-605"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71482164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Book Review for Neuromuscular and Electrodiagnostic Medicine Board Review.","authors":"Nicholas Purcell, Pitcha Chompoopong","doi":"10.1097/WNP.0000000000001111","DOIUrl":"https://doi.org/10.1097/WNP.0000000000001111","url":null,"abstract":"","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":"41 7","pages":"652-653"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}