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1.

Objective

Delirium is a common post-operative complication associated with significant costs, morbidity, and mortality. We sought sleep/EEG predictors of delirium present prior to delirium symptoms to facilitate developing and targeting therapies.

Methods

Continuous EEG data were obtained in 12 patients post-orthopedic surgery from the day of surgery until delirium assessment on post-operative day 2 (POD2).

Results

Diminished total sleep time (r = ?0.68; p < 0.05) and longer latency to sleep onset (r = 0.67; p < 0.05) on the first night in the hospital were associated with greater POD2 delirium severity. Patients experiencing delirium slept 2.4 h less and took 2 h longer to fall asleep. Greater waking EEG delta power (r = 0.84; p < 0.05) on POD1 and less non-REM sleep EEG delta power (r = ?0.72; p < 0.05) on night 2 also predicted POD2 delirium severity.

Conclusions

Loss of sleep on night1 post-surgery is an early predictor of subsequent delirium. EEG Delta Power alterations in waking and sleep appear to be later indicators of impending delirium. Further work is needed to evaluate reproducibility/generalizability and assess whether sleep loss contributes to causing delirium.

Significance

This first study to prospectively collect continuous EEG data for an extended period prior to delirium onset identified EEG-derived indices that predict subsequent delirium that could aid in developing and targeting therapies.  相似文献   

2.

Objective

To describe EEG and clinical correlates, DC recordings and prognostic significance of cyclic seizures (CS).

Methods

We reviewed our prospective continuous EEG database to identify patients with CS, controls with non-cyclic status epilepticus (SE) and controls without seizure matched for age and etiology. EEG was reviewed with DC settings.

Results

39/260 (15%) patients with electrographic seizures presented with CS. These patients were older (62 vs. 54 years; p = 0.04) and more often had acute or progressive brain injury (77% vs. 52%; p = 0.03) than patients with non-cyclic SE and had a lower level of consciousness, were more severely ill, than matched controls. CS almost always had focal onset, often from posterior regions. Patients with CS trended towards worse prognosis. When available (12 patients), DC recordings showed an infraslow cyclic oscillation of EEG baseline synchronized to the seizures in all cases.

Conclusions

CS occur mostly in older patients with acute or progressive brain injury, are more likely to be associated with poor outcome than patients with other forms of nonconvulsive SE, and are accompanied by synchronous oscillations of the EEG baseline on DC recordings.

Significance

CS are a common form of non-convulsive status epilepticus in critically ill patients and provide further insights into the relationship between infraslow activity and seizures; further study on this relationship may shed light on the mechanisms of seizure initiation and termination.  相似文献   

3.

Objectives

(A) To develop a TMS–EEG stimulation and data analysis protocol in genetic generalized epilepsy (GGE). (B) To investigate the diagnostic accuracy of TMS–EEG in GGE.

Methods

Pilot experiments resulted in the development and optimization of a paired-pulse TMS–EEG protocol at rest, during hyperventilation (HV), and post-HV combined with multi-level data analysis. This protocol was applied in 11 controls (C) and 25 GGE patients (P), further dichotomized into responders to antiepileptic drugs (R, n = 13) and non-responders (n-R, n = 12).Features (n = 57) extracted from TMS–EEG responses after multi-level analysis were given to a feature selection scheme and a Bayesian classifier, and the accuracy of assigning participants into the classes P-C and R-nR was computed.

Results

On the basis of the optimal feature subset, the cross-validated accuracy of TMS–EEG for the classification P-C was 0.86 at rest, 0.81 during HV and 0.92 at post-HV, whereas for R-nR the corresponding figures are 0.80, 0.78 and 0.65, respectively. Applying a fusion approach on all conditions resulted in an accuracy of 0.84 for the classification P-C and 0.76 for the classification R-nR.

Conclusion

TMS–EEG can be used for diagnostic purposes and for assessing the response to antiepileptic drugs.

Significance

TMS–EEG holds significant diagnostic potential in GGE.  相似文献   

4.

Objectives

Electroencephalography (EEG) is one of the methods used in predicting the outcome after cerebral hypoxia. In this study we aim to evaluate the significance of generalized periodic discharges (GPD) as a prognostic marker.

Methods

We retrospectively analyzed the medical histories of patients, who underwent an EEG after cardiac arrest during the time period from 2005 to 2013 at the University Hospital Zurich. All EEGs were re-interpreted using the 2012 American Clinical Neurophysiology Society (ACNS) classification for intensive care unit (ICU) EEGs.

Results

Out of 131 patients, in which an EEG was recorded after cardiopulmonary resuscitation, 119 were included in our study. The average interval between cardiac arrest and EEG-recording was 3.8 ± 3.0 days (range: 0–14 days). Persistent GPDs (i.e. GPDs more than 24 h after the event) were found in thirty-two (26.9%) of the patients initial EEGs. The appearance of persistent GPDs preceded fatal outcome in 100% of all cases (vs. 69.0% in the non-GPD-group, p < 0.0001).

Conclusion

Among other encephalopathic markers in EEG persistent GPDs are a highly specific prognostic marker of fatal outcome in patients with hypoxic encephalopathy.

Significance

Using standardized EEG interpretation, this study identified persistent GPDs as a specific prognostic marker in post cardiac arrest syndrome.  相似文献   

5.

Objective

To compare the diagnostic accuracy of standard (st) and long-term video (lt) EEG in elderly patients with suspected non-convulsive seizures.

Methods

Over a 12-month period, we prospectively included all elderly (over-65) hospitalized patients having undergone lt-EEG for suspected non-convulsive seizures (n = 43). st-EEG was defined as the first 20 min of each lt-EEG. We recorded the patients’ clinical and imaging characteristics and final diagnosis and assessed the respective diagnostic values of st-EEG and lt-EEG.

Results

Epileptiform discharges were detected on standard EEG in only 7% of patients and in 28% of patients on Lt-EEG (p = 0.004). Non-convulsive seizures were recorded in 1 case vs. 4, respectively. Nine of 40 negative standard EEG showed later epileptiform activities. The median time to occurrence of the first epileptiform activities was 46.5 min (interquartile range: 36.5–239.75 min). Epileptiform activity occurred during sleep only in 33% patients with a negative st-EEG. Dementia was associated with a positive lt-EEG (p:0.047).

Conclusion

Lt-EEG was clearly superior to standard EEG for detecting epileptiform activity in elderly when suspecting non convulsive seizures.

Significance

St-EEG has a low diagnostic yield in elderly patients with suspected non-convulsive seizures and so lt-EEG is preferable in this situation.  相似文献   

6.

Objective

In mesial temporal lobe (mTL) epilepsy, seizure onset can precede the appearance of a scalp EEG ictal pattern by many seconds. The ability to identify this early, occult mTL seizure activity could improve lateralization and localization of mTL seizures on scalp EEG.

Methods

Using scalp EEG spectral features and machine learning approaches on a dataset of combined scalp EEG and foramen ovale electrode recordings in patients with mTL epilepsy, we developed an algorithm, SCOPE-mTL, to detect and lateralize early, occult mTL seizure activity, prior to the appearance of a scalp EEG ictal pattern.

Results

Using SCOPE-mTL, 73% of seizures with occult mTL onset were identified as such, and no seizures that lacked an occult mTL onset were identified as having one. Predicted mTL seizure onset times were highly correlated with actual mTL seizure onset times (r = 0.69). 50% of seizures with early mTL onset were lateralizable prior to scalp ictal onset, with 94% accuracy.

Conclusions

SCOPE-mTL can identify and lateralize mTL seizures prior to scalp EEG ictal onset, with high sensitivity, specificity, and accuracy.

Significance

Quantitative analysis of scalp EEG can provide important information about mTL seizures, even in the absence of a visible scalp EEG ictal correlate.  相似文献   

7.

Objectives

To describe the hippocampal stereo-electroencephalogram during sleep according to sleep stages (including N2 sleep) and cycles, together with the hippocampal spindles.

Methods

All patients with drug-resistant focal epilepsy undergoing intra-hippocampal implantation between August 2012 and June 2013 at Nancy University Hospital were screened. Six patients with explored hippocampus devoid of pathological features were analyzed. During one night, we identified continuous periods of successive N2, N3 and REM sleep for two full cycles. We performed a spectral analysis of the hippocampal signal for each labeled sleep period.

Results

N2, N3 and REM sleeps were individualized according to their spectral powers, for each frequency band and sleep cycle. Hippocampal spindles showed dynamic intrinsic properties, the 11.5–16 Hz frequency band being mainly dominant, whereas the 9–11.5 Hz frequency band heightening during the beginning and the end of the transient. For N3 and REM sleep stages, the power of the hippocampal signal was significantly decreased between the first and the second sleep cycle.

Conclusion

Distinct N2 sleep, fast spindles and homeostatic profile are all common properties shared by hippocampus and cortex during sleep.

Significance

The close functional link between hippocampus and cortex may have various sleep-related substrates.  相似文献   

8.
9.

Objective

We studied the correlation between motor evoked potentials (MEPs) and early TMS-evoked EEG potentials (TEPs) from single-pulse TMS before and after intermittent Theta Burst Stimulation (iTBS) to the left primary motor cortex (M1) in 17 healthy older participants.

Methods

TMS was targeted to the hand region of M1 using a MRI-guided navigated brain stimulation system and a figure-of-eight biphasic coil. MEPs were recorded from the right first dorsal interosseous muscle using surface EMG. TEPs were extracted from a 61-channel EEG recording. Participants received 90 single TMS pulses at 120% of resting motor threshold before and after iTBS.

Results

Across all participants, the change in N15-P30 TEP and MEP amplitudes were significantly correlated (r = 0.69; p < 0.01). Average TEP responses did not change significantly after iTBS, whereas MEP amplitudes showed a significant increase.

Conclusions

Changes in corticospinal reactivity and cortical reactivity induced by iTBS are related. However, the effect of iTBS on TEPs, unlike MEPs, is not straightforward.

Significance

Our findings help elucidate the relationship between changes in cortical and corticospinal excitability in healthy older individuals. Going forward, TEPs may be used to evaluate the effects of theta-burst stimulation in non-motor brain regions.  相似文献   

10.

Objective

This study investigated sensitivity and false detection rate of a multimodal automatic seizure detection algorithm and the applicability to reduced electrode montages for long-term seizure documentation in epilepsy patients.

Methods

An automatic seizure detection algorithm based on EEG, EMG, and ECG signals was developed. EEG/ECG recordings of 92 patients from two epilepsy monitoring units including 494 seizures were used to assess detection performance. EMG data were extracted by bandpass filtering of EEG signals. Sensitivity and false detection rate were evaluated for each signal modality and for reduced electrode montages.

Results

All focal seizures evolving to bilateral tonic-clonic (BTCS, n = 50) and 89% of focal seizures (FS, n = 139) were detected. Average sensitivity in temporal lobe epilepsy (TLE) patients was 94% and 74% in extratemporal lobe epilepsy (XTLE) patients. Overall detection sensitivity was 86%. Average false detection rate was 12.8 false detections in 24 h (FD/24 h) for TLE and 22 FD/24 h in XTLE patients. Utilization of 8 frontal and temporal electrodes reduced average sensitivity from 86% to 81%.

Conclusion

Our automatic multimodal seizure detection algorithm shows high sensitivity with full and reduced electrode montages.

Significance

Evaluation of different signal modalities and electrode montages paces the way for semi-automatic seizure documentation systems.  相似文献   

11.

Objective

To assess interrater agreement based on majority voting in visual scoring of neonatal seizures.

Methods

An online platform was designed based on a multicentre seizure EEG-database. Consensus decision based on ‘majority voting’ and interrater agreement was estimated using Fleiss’ Kappa. The influences of different factors on agreement were determined.

Results

1919 Events extracted from 280 h EEG of 71 neonates were reviewed by 4 raters. Majority voting was applied to assign a seizure/non-seizure classification. 44% of events were classified with high, 36% with moderate, and 20% with poor agreement, resulting in a Kappa value of 0.39. 68% of events were labelled as seizures, and in 46%, all raters were convinced about electrographic seizures. The most common seizure duration was <30 s. Raters agreed best for seizures lasting 60–120 s. There was a significant difference in electrographic characteristics of seizures versus dubious events, with seizures having longer duration, higher power and amplitude.

Conclusions

There is a wide variability in identifying rhythmic ictal and non-ictal EEG events, and only the most robust ictal patterns are consistently agreed upon. Database composition and electrographic characteristics are important factors that influence interrater agreement.

Significance

The use of well-described databases and input of different experts will improve neonatal EEG interpretation and help to develop uniform seizure definitions, useful for evidence-based studies of seizure recognition and management.  相似文献   

12.

Objective

This study aimed to identify the subtype of interictal ripples that help delineate the epileptogenic zone in neocortical epilepsy.

Methods

Totally 25 patients with focal neocortical epilepsy who had invasive electroencephalography (EEG) evaluation and subsequent surgery were included. They were followed up for at least 2 years. Interictal ripples (80–250 Hz) and fast ripples (250–500 Hz) during slow-wave sleep were identified. Neocortical ripples were defined as type I ripples when they were superimposed on epileptiform discharges, and as type II ripples when they occurred independently. Resection ratio was calculated to present the extent to which the cortical area showing an interictal event or the seizure onset zone (SOZ) was completely removed.

Results

Fast ripples and types I and II ripples were found in 8, 19, and 21 patients, respectively. Only the higher resection ratio of interictal fast or type I ripples was correlated to the Engel 1a surgical outcome.

Conclusions

Type I ripples could assist in localizing the epileptogenic zone in neocortical epilepsy.

Significance

Type I and fast ripples both may be pathological high-frequency oscillations.  相似文献   

13.

Objective

Young children with congenital visual impairment (VI) are at increased risk of behavioral vulnerabilities. Studies on ‘at risk’ populations suggest that frontal EEG asymmetry may be associated with behavioral risk. We investigated frontal asymmetry at 1 year (Time 1), behavior at 2 years (Time 2) and their longitudinal associations within a sample of infants with VI. Frontal asymmetry in the VI sample at 1 year was also compared cross-sectionally to an age-matched typically sighted (TS) group.

Methods

At Time 1, 22 infants with VI and 10 TS infants underwent 128-channel EEG recording. Frontal asymmetry ratios were calculated from power spectral density values in the alpha frequency band. At Time 2, Achenbach Child Behavior Checklist data was obtained for the VI sample.

Results

63.6% of the VI sample and 50% of the TS sample showed left frontal asymmetry; no significant difference in frontal asymmetry was found between the two groups. 22.7% of the VI sample had subclinical to clinical range ‘internalizing’ behavior difficulties. Greater left frontal asymmetry at one year was significantly associated with greater emotionally reactive scores at two years within the VI sample (r = 0.50, p = 0.02).

Conclusions

Left frontal asymmetry correlates with later behavior risk within this vulnerable population.

Significance

These findings make an important first contribution regarding the utility of frontal EEG asymmetry as a method to investigate risk in infants with VI.  相似文献   

14.

Objective

The discontinuation of antiepileptic drugs (AEDs) is an important treatment decision for epilepsy patients who have been seizure-free for 2 years or longer. Some patients experience seizures relapse after AED withdrawal. The prognostic value of electroencephalograms (EEGs) for seizure relapse following AED withdrawal is controversial. To our knowledge, this is the first meta-analysis to address whether EEG data can be used to guide the discontinuation of AEDs.

Method

We performed a meta-analysis of cohort studies that reported original EEG data from before AED withdrawal and recurrence after AED-withdrawal. The quality of each study was assessed using the Newcastle–Ottawa Scale.

Results

Fifteen studies including a total of 2349 participants were included in this meta-analysis. This meta-analysis of 15 studies demonstrates that an abnormal electroencephalogram was a predictor of the risk of relapse. Additionally, paroxysmal, slowing, spike and wave activities on electroencephalograms were associated with increased risk of relapse.

Conclusion

We reveal that abnormal EEG records, particularly paroxysmal abnormalities, before AED withdrawal predicted a high risk of relapse. Slowing and spike and wave activities also exhibited moderate predictive values.

Significance

Our findings suggest that, EEGs might be an important prognostic tool for antiepileptic drug reduction.  相似文献   

15.

Objective

Classify rhythmic EEG patterns in extremely preterm infants and relate these to brain injury and outcome.

Methods

Retrospective analysis of 77 infants born <28 weeks gestational age (GA) who had a 2-channel EEG during the first 72?h after birth. Patterns detected by the BrainZ seizure detection algorithm were categorized: ictal discharges, periodic epileptiform discharges (PEDs) and other waveforms. Brain injury was assessed with sequential cranial ultrasound (cUS) and MRI at term-equivalent age. Neurodevelopmental outcome was assessed with the BSITD-III (2 years) and WPPSI-III-NL (5 years).

Results

Rhythmic patterns were observed in 62.3% (ictal 1.3%, PEDs 44%, other waveforms 86.3%) with multiple patterns in 36.4%. Ictal discharges were only observed in one and excluded from further analyses. The EEG location of the other waveforms (p < 0.05), but not PEDs (p = 0.238), was significantly associated with head position. No relation was found between the median total duration of each pattern and injury on cUS and MRI or cognition at 2 and 5 years.

Conclusions

Clear ictal discharges are rare in extremely preterm infants. PEDs are common but their significance is unclear. Rhythmic waveforms related to head position are likely artefacts.

Significance

Rhythmic EEG patterns may have a different significance in extremely preterm infants.  相似文献   

16.

Objective

We evaluated the performance of our previously developed seizure prediction approach on thirty eight seizures from ten patients with focal hippocampal epilepsy.

Methods

The seizure prediction system was developed based on the extraction of correlation dimension, correlation entropy, noise level, Lempel-Ziv complexity, largest Lyapunov exponent, and nonlinear interdependence from segments of intracranial EEG.

Results

Our results showed an average sensitivity of 86.7% and 92.9%, an average false prediction rate of 0.126 and 0.096/h, and an average minimum prediction time of 14.3 and 33.3 min, respectively, using seizure occurrence periods of 30 and 50 min and a seizure prediction horizon of 10 s. Two-third of the analyzed seizures showed significantly increased complexity in periods prior to the seizures in comparison with baseline.In four patients, strong bidirectional connectivities between epileptic contacts and the surrounding areas were observed. However, in five patients, unidirectional functional connectivities in preictal periods were observed from remote areas to epileptogenic zones.

Conclusions

Overall, preictal periods in patients with focal hippocampal epilepsy were characterized with patient-specific changes in univariate and bivariate nonlinear measures.

Significance

The spatio-temporal characterization of preictal periods may help to better understand the mechanism underlying seizure generation in patients with focal hippocampal epilepsy.  相似文献   

17.

Objective

The aim of the study was to describe the relationship between electroencephalographic (EEG) findings obtained by standardized visual analysis, subclinical white matter lesions (WML) and brain atrophy in a large memory clinic population.

Methods

Patients with Alzheimer’s disease (AD, n = 58), mild cognitive impairment (MCI, n = 141), subjective cognitive impairment (SCI, n = 194) had clinical, MRI based WML severity and regional atrophy assessments, and routine resting EEG recording. Background activity (BA) and episodic and continuous abnormalities were assessed visually in EEG.

Results

WML (p = 0.006) and atrophy in medial temporal regions (MTA) (p = <0.001) were associated with slower BA in all diagnoses. WML were associated in SCI with total episodic EEG abnormalities (p = 0.03).

Conclusions

EEG is associated with subclinical WML burden and cortical brain atrophy in a memory clinic population.

Significance

Even the standard visually assessed EEG can complement a memory clinic diagnostic workup.  相似文献   

18.

Objective

To investigate the effect of systematic electrode reduction from a common 10-20 EEG system on pattern detection sensitivity (SEN).

Methods

Two reviewers rated 17130 one-minute segments of 83 prospectively recorded cEEGs according to the ACNS standardized critical care EEG terminology (CCET), including burst suppression patterns (BS) and unequivocal electrographic seizures. Consensus annotations between reviewers were used as a gold standard to determine pattern detection SEN and specificity (SPE) of a computational algorithm (baseline, 19 electrodes). Electrodes were than reduced one by one in four different variations. SENs and SPEs were calculated to determine the most beneficial assembly with respect to the number and location of electrodes.

Results

High automated baseline SENs (84.99–93.39%) and SPEs (90.05–95.6%) were achieved for all patterns. Best overall results in detecting BS and CCET patterns were found using the “hairline + vertex” montage. While the “forehead + behind ear” montage showed an advantage in detecting ictal patterns, reaching a 15% drop of SEN with 10 electrodes, all montages could detect BS sufficiently if at least nine electrodes were available.

Conclusion

For the first time an automated approach was used to systematically evaluate the effect of electrode reduction on pattern detection SEN in cEEG.

Significance

Prediction of the expected detection SEN of specific EEG patterns with reduced EEG montages in ICU patients.  相似文献   

19.

Objectives

Aim of this study was to analyze whether electroencephalogram (EEG)-based CNS-arousal markers differ for patients suffering from obsessive compulsive disorder (OCD) that either respond or do not respond to cognitive behavioral therapy (CBT), selective serotonin reuptake inhibitors (SSRIs) or their combination. Further the study aimed to identify specific response-predictors for the different therapy approaches.

Methods

CNS-arousal from 51 unmedicated patients during fifteen-minute resting state was assessed using VIGALL (Vigilance Algorithm Leipzig). Clinical Global Impression (CGI) scores were used to assess response or non-response after three to six months following therapy (CBT, n = 18; SSRI, n = 11 or combination, n = 22). Differences between Responders (R) and Non-Responders (NR) were identified using multivariate analysis of covariance (MANCOVA) models.

Results

MANCOVA revealed that Responders spent significant less time at the highest CNS-arousal stage 0. Further, low amounts of the highest CNS-arousal stages were specifically predictive for a response to a combined treatment approach.

Conclusions

The fact that CNS-arousal markers allowed discrimination between Responders and Non-Responders and also between Responders of different treatment arms underlines a possible clinical value of EEG-based markers.

Significance

These results encourage further research on EEG-arousal regulation for determining pathophysiological subgroups for treatment response.  相似文献   

20.

Objective

The detectability of high frequency oscillations (HFO, >200 Hz) in the intraoperative ECoG is restricted by their low signal-to-noise ratio (SNR). Using the somatosensory evoked HFO, we quantify how HFO detectability can benefit from a custom-made low-noise amplifier (LNA).

Methods

In 9 patients undergoing tumor surgery in the central region, subdural strip electrodes were placed for intraoperative neurophysiological monitoring. We recorded the somatosensory evoked potential (SEP) simultaneously by custom-made LNA and by a commercial device (CD). We varied the stimulation rate between 1.3 and 12.7 Hz to tune the SNR of the N20 component and the evoked HFO and quantified HFO detectability at the single trial level. In three patients we compared Propofol® and Sevoflurane® anesthesia.

Results

In the average, amplitude decreased in both in N20 and evoked HFO amplitude with increasing stimulation rate (p < 0.05). We detected a higher percentage of single trial evoked HFO with the LNA (p < 0.001) for recordings with low impedance (<5 kΩ). Average amplitudes were indistinguishable between anesthesia compounds.

Conclusion

Low-noise amplification improves the detection of the evoked HFO in recordings with subdural electrodes with low impedance.

Significance

Low-noise EEG might critically improve the detectability of interictal spontaneous HFO in subdural and possibly in scalp recordings.  相似文献   

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