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Benghanem S, Kubis N, Gayat E, Loiodice A, Pruvost-Robieux E, Sharshar T, Foucrier A, Figueiredo S, Bouilleret V, De Montmollin E, Bagate F, Lefaucheur JP, Guidet B, Appartis E, Cariou A, Varnet O, Jost PH, Megarbane B, Degos V, Le Guennec L, Naccache L, Legriel S, Woimant F, Gregoire C, Cortier D, Crassard I, Timsit JF, Mazighi M, Sonneville R. Prognostic value of early EEG abnormalities in severe stroke patients requiring mechanical ventilation: a pre-planned analysis of the SPICE prospective multicenter study. Crit Care 2024; 28:173. [PMID: 38783313 PMCID: PMC11119574 DOI: 10.1186/s13054-024-04957-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 05/17/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Prognostication of outcome in severe stroke patients necessitating invasive mechanical ventilation poses significant challenges. The objective of this study was to assess the prognostic significance and prevalence of early electroencephalogram (EEG) abnormalities in adult stroke patients receiving mechanical ventilation. METHODS This study is a pre-planned ancillary investigation within the prospective multicenter SPICE cohort study (2017-2019), conducted in 33 intensive care units (ICUs) in the Paris area, France. We included adult stroke patients requiring invasive mechanical ventilation, who underwent at least one intermittent EEG examination during their ICU stay. The primary endpoint was the functional neurological outcome at one year, determined using the modified Rankin scale (mRS), and dichotomized as unfavorable (mRS 4-6, indicating severe disability or death) or favorable (mRS 0-3). Multivariable regression analyses were employed to identify EEG abnormalities associated with functional outcomes. RESULTS Of the 364 patients enrolled in the SPICE study, 153 patients (49 ischemic strokes, 52 intracranial hemorrhages, and 52 subarachnoid hemorrhages) underwent at least one EEG at a median time of 4 (interquartile range 2-7) days post-stroke. Rates of diffuse slowing (70% vs. 63%, p = 0.37), focal slowing (38% vs. 32%, p = 0.15), periodic discharges (2.3% vs. 3.7%, p = 0.9), and electrographic seizures (4.5% vs. 3.7%, p = 0.4) were comparable between patients with unfavorable and favorable outcomes. Following adjustment for potential confounders, an unreactive EEG background to auditory and pain stimulations (OR 6.02, 95% CI 2.27-15.99) was independently associated with unfavorable outcomes. An unreactive EEG predicted unfavorable outcome with a specificity of 48% (95% CI 40-56), sensitivity of 79% (95% CI 72-85), and positive predictive value (PPV) of 74% (95% CI 67-81). Conversely, a benign EEG (defined as continuous and reactive background activity without seizure, periodic discharges, triphasic waves, or burst suppression) predicted favorable outcome with a specificity of 89% (95% CI 84-94), and a sensitivity of 37% (95% CI 30-45). CONCLUSION The absence of EEG reactivity independently predicts unfavorable outcomes at one year in severe stroke patients requiring mechanical ventilation in the ICU, although its prognostic value remains limited. Conversely, a benign EEG pattern was associated with a favorable outcome.
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Affiliation(s)
- Sarah Benghanem
- AP-HP.Centre, Medical ICU, Cochin Hospital, Paris, France
- University Paris Cité, Medical School, Paris, France
- INSERM UMR 1266, Institut de Psychiatrie et Neurosciences de Paris-IPNP, Paris, France
| | - Nathalie Kubis
- University Paris Cité, Medical School, Paris, France
- APHP.Nord, Clinical Physiology Department, UMRS_1144, Université Paris Cite, Paris, France
| | - Etienne Gayat
- University Paris Cité, Medical School, Paris, France
- APHP.Nord, Department of Anesthesiology and Critical Care, DMU Parabol, Université Paris Cite, Paris, France
| | | | - Estelle Pruvost-Robieux
- University Paris Cité, Medical School, Paris, France
- INSERM UMR 1266, Institut de Psychiatrie et Neurosciences de Paris-IPNP, Paris, France
- Neurophysiology and Epileptology Department, GHU Psychiatry & Neurosciences, Sainte Anne, Paris, France
| | - Tarek Sharshar
- University Paris Cité, Medical School, Paris, France
- Department of Neuroanesthesiology and Intensive Care, Sainte Anne Hospital, Paris, France
| | - Arnaud Foucrier
- APHP, Department of Anesthesiology and Critical Care, Beaujon University Hospital, Clichy, France
| | - Samy Figueiredo
- APHP, Department of Anesthesiology and Critical Care, Bicêtre University Hospitals, Le Kremlin Bicêtre, France
| | - Viviane Bouilleret
- Neurophysiology and Epileptology Department, Bicêtre University Hospitals, Le Kremlin Bicêtre, France
| | | | - François Bagate
- APHP, Department of Intensive Care Medicine, Henri Mondor University Hospital and Université de Paris Est Créteil, Créteil, France
| | | | - Bertrand Guidet
- APHP, Department of Intensive Care Medicine, Saint Antoine University Hospital, Paris, France
| | - Emmanuelle Appartis
- Neurophysiology Department, Saint Antoine University Hospital, Paris, France
| | - Alain Cariou
- AP-HP.Centre, Medical ICU, Cochin Hospital, Paris, France
- University Paris Cité, Medical School, Paris, France
| | - Olivier Varnet
- APHP, Department of Physiology, Bichat-Claude Bernard University Hospital, 75018, Paris, France
| | - Paul Henri Jost
- APHP, Department of Anesthesiology and Intensive Care, Henri Mondor Hospital, Creteil, France
| | | | - Vincent Degos
- APHP, Department of Anesthesiology and Neurointensive Care, Pitié Salpétrière Hospital, Paris, France
| | - Loic Le Guennec
- APHP, Medical ICU, Pitié Salpétrière Hospital, Paris, France
| | - Lionel Naccache
- APHP, Department of Physiology, Pitié Salpétrière Hospital, Paris, France
| | | | | | - Charles Gregoire
- Department of Intensive Care, Rothschild Hospital Foundation, Paris, France
| | - David Cortier
- Department of Intensive Care, Foch Hospital, Paris, France
| | | | - Jean-François Timsit
- APHP, Department of Intensive Care Medicine, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75018, Paris, France
- Université Paris Cité, INSERM UMR 1137, IAME, Paris, France
| | - Mikael Mazighi
- APHP Nord, Department of Neurology, Lariboisière University Hospital, Department of Interventional Neuroradiology, Fondation Rothschild Hospital, FHU Neurovasc, Paris, France
- Université Paris Cité, INSERM UMR 1144, Paris, France
| | - Romain Sonneville
- APHP, Department of Intensive Care Medicine, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75018, Paris, France.
- Université Paris Cité, INSERM UMR 1137, IAME, Paris, France.
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Bernardes TS, Santos KCS, Nascimento MR, Filho CANES, Bazan R, Pereira JM, de Souza LAPS, Luvizutto GJ. Effects of anodal transcranial direct current stimulation over motor cortex on resting-state brain activity in the early subacute stroke phase: A power spectral density analysis. Clin Neurol Neurosurg 2024; 237:108134. [PMID: 38335706 DOI: 10.1016/j.clineuro.2024.108134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/06/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024]
Abstract
INTRODUCTION Despite promising results, the effects of transcranial direct current stimulation (tDCS) in the early stages of stroke and its impact on brain activity have been poorly studied. Therefore, this study aimed to investigate the effect of tDCS applied over the ipsilesional motor cortex on resting-state brain activity in the early subacute phase of stroke. METHODS This is a pilot, randomized, double-blind, proof-of-concept study. The patients with stroke were randomly assigned into two groups: anodal tDCS (A-tDCS) or sham tDCS (S-tDCS). For A-tDCS, the anode was placed over the ipsilesional motor cortex, while the cathode was placed over the left or right supraorbital area (Fp2 for left stroke or Fp1 for right stroke). For the real stimulation, a constant current of 1.0 mA was delivered for 20 min and then ramped down linearly for 30 s, maintaining a resistance below 10 kΩ. For the sham stimulation, the stimulator was turned on, and the current intensity was gradually increased for 30 s, tapered off over 30 s, and maintained for 30 min without stimulation. Each stimulation was performed for three consecutive sessions with an interval of 1 h between them. The primary outcome was spectral electroencephalography (EEG) analysis based on the Power Spectral Density (PSD) determined by EEG records of areas F3, F4, C3, C4, P3, and P4. Brain Vision Analyzer software processed the signals, EEG power spectral density (PSD) was calculated before and after stimulation, and alpha, beta, delta, and theta power were analyzed. The secondary outcomes included hemodynamic variables based on the difference between baseline (D0) and post-intervention session (D1) values of systolic (SBP) and diastolic (DBP) blood pressure, heart rate (HR), respiratory rate (RR) and peripheral oxygen saturation (SPO2). Mann-Whitney test was used to compare position measurements of two independent samples; Fisher's exact test was used to compare two proportions; paired Wilcoxon signed-rank test was used to compare the median differences in the within-group comparison, and Spearman correlations matrix among spectral power analysis between EEG bands was performed to verify consistency of occurrence of oscillations. Statistical significance was set at P < 0.05. RESULTS An increase in PSD in the alpha frequency in the P4 region was observed after the intervention in the A-tDCS group, as compared to the placebo group (before = 6.13; after = 10.45; p < 0.05). In the beta frequency, an increase in PSD was observed in P4 (before = 4.40; after = 6.79; p < 0.05) and C4 (before = 4.43; after = 6.94; p < 0.05) after intervention in the A-tDCS group. There was a reduction in PSD at delta frequency in C3 (before = 293.8; after = 58.6; p < 0.05) after intervention in the A-tDCS group. In addition, it was observed a strong relationship between alpha and theta power in the A-tDCS group before and after intervention. However, the sham group showed correlations between more power bands (alpha and theta, alpha and delta, and delta and theta) after intervention. There was no difference in hemodynamic variables between the intra- (before and after stimulation) and inter-groups (mean difference). CONCLUSION Anodal tDCS over the ipsilesional motor cortex had significant effects on the brain electrical activity in the early subacute stroke phase, increasing alpha and beta wave activities in sensorimotor regions while reducing slow delta wave activity in motor regions. These findings highlight the potential of anodal tDCS as a therapeutic intervention in the early stroke phase.
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Affiliation(s)
- Tiago Soares Bernardes
- Department of Medicine, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
| | - Kelly Cristina Sousa Santos
- Department of Applied Physical Therapy, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
| | - Monalisa Resende Nascimento
- Department of Applied Physical Therapy, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
| | | | - Rodrigo Bazan
- Department of Neurology, Psychology, and Psychiatry, Botucatu Medical School (UNESP), Botucatu, SP, Brazil
| | - Janser Moura Pereira
- Statistical Department, Universidade Federal de Uberlândia (UFU), Uberlândia, MG, Brazil
| | | | - Gustavo José Luvizutto
- Department of Applied Physical Therapy, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil.
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Casagrande S, Zuliani L, Grisold W. Paraneoplastic encephalitis. HANDBOOK OF CLINICAL NEUROLOGY 2024; 200:131-149. [PMID: 38494274 DOI: 10.1016/b978-0-12-823912-4.00019-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
The first reports of encephalitis associated with cancer date to the 1960s and were characterized by clinical and pathologic involvement of limbic areas. This specific association was called limbic encephalitis (LE). The subsequent discovery of several "onconeural" antibodies (Abs), i.e., Abs targeting an antigen shared by neurons and tumor cells, supported the hypothesis of an autoimmune paraneoplastic etiology of LE and other forms of rapidly progressive encephalopathy. Over the past 20 years, similar clinical pictures with different clinical courses have been described in association with novel Abs-binding neuronal membrane proteins and proved to be pathogenic. The most well-known encephalitis in this group was described in 2007 as an association of a complex neuro-psychiatric syndrome, N-methyl-d-aspartate (NMDA) receptor-Abs, and ovarian teratoma in young women. Later on, nonparaneoplastic cases of NMDA receptor encephalitis were also described. Since then, the historical concept of LE and Ab associated encephalitis has changed. Some of these occur in fact more commonly in the absence of a malignancy (e.g., anti-LG1 Abs). Lastly, seronegative cases were also described. The term paraneoplastic encephalitis nowadays encompasses different syndromes that may be triggered by occult tumors.
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Affiliation(s)
- Silvia Casagrande
- Neurology Unit, Rovereto Hospital, Trento, Italy; Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy.
| | - Luigi Zuliani
- Department of Neurology, San Bortolo Hospital, Azienda ULSS8 Berica, Vicenza, Italy
| | - Wolfgang Grisold
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
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Pérez IF, Villagra TB, Jiménez-Balado J, Redondo JJ, Recasens BB. Risk factors and outcome of epilepsy in adults with cerebral palsy or intellectual disability. Epilepsy Behav 2023; 147:109450. [PMID: 37769423 DOI: 10.1016/j.yebeh.2023.109450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/02/2023] [Accepted: 09/14/2023] [Indexed: 09/30/2023]
Abstract
INTRODUCTION Epilepsy is found in 10-60% of individuals with cerebral palsy (CP) and 5.5-35% with intellectual disability (ID). However, little is known about the long-term evolution of epilepsy among adults. The aim of the study is to describe the factors associated with epilepsy and its outcome in a population of adults with CP or ID. METHODS This retrospective study reviewed the medical records of 306 individuals with CP/ID. All individuals underwent neurological, psychiatric, and neuropsychological follow-ups. RESULTS In the cohort, 72.5% of the individuals had a CP diagnosis, with a mean age of 36.4 years (IQR 24.0-46.0). Epilepsy was present in 55.6% of the individuals and was associated with CP (p < 0.01), spastic subtype (p < 0.01), a higher degree of ID (p < 0.01), hemorrhagic and congenital malformation etiologies (p 0.011), abnormal neuroimaging (p < 0.01), and worse scores on motor and communication scales (p < 0.01). Drug-resistant epilepsy (DRE) (22.4%) was associated with higher scores on motor scales (p < 0.01). Additionally, 42.3% of the individuals who attempted antiseizure medication (ASM) withdrawal experienced recurrence, which was associated with epileptic activity on the electroencephalogram (EEG) (p 0.004). CONCLUSIONS Epilepsy is a common comorbidity in adults with CP or ID and is associated with greater brain damage and a more severe phenotype. Seizure recurrence after ASM withdrawal occurred in half of the individuals and was associated with epileptic activity on the EEG.
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Affiliation(s)
- Isabel Fernández Pérez
- Neurology Department, Fundació ASPACE Catalunya, Barcelona, Spain; Neurology Department, Hospital del Mar, Barcelona, Spain
| | | | - Joan Jiménez-Balado
- Neurovascular Research Lab, Hospital del Mar Research Institute, Barcelona, Spain
| | - Jordi Jiménez Redondo
- Technical Secretariat and Research Commission, Fundació ASPACE Catalunya, Barcelona, Spain
| | - Bernat Bertran Recasens
- Neurology Department, Fundació ASPACE Catalunya, Barcelona, Spain; Neurology Department, Hospital del Mar, Barcelona, Spain.
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Rubinos C, Bruzzone MJ, Viswanathan V, Figueredo L, Maciel CB, LaRoche S. Electroencephalography as a Biomarker of Prognosis in Acute Brain Injury. Semin Neurol 2023; 43:675-688. [PMID: 37832589 DOI: 10.1055/s-0043-1775816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
Electroencephalography (EEG) is a noninvasive tool that allows the monitoring of cerebral brain function in critically ill patients, aiding with diagnosis, management, and prognostication. Specific EEG features have shown utility in the prediction of outcomes in critically ill patients with status epilepticus, acute brain injury (ischemic stroke, intracranial hemorrhage, subarachnoid hemorrhage, and traumatic brain injury), anoxic brain injury, and toxic-metabolic encephalopathy. Studies have also found an association between particular EEG patterns and long-term functional and cognitive outcomes as well as prediction of recovery of consciousness following acute brain injury. This review summarizes these findings and demonstrates the value of utilizing EEG findings in the determination of prognosis.
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Affiliation(s)
- Clio Rubinos
- Department of Neurology, University of North Carolina, Chapel Hill, North Carolina
| | | | - Vyas Viswanathan
- Department of Neurology, University of North Carolina, Chapel Hill, North Carolina
| | - Lorena Figueredo
- Department of Neurology, University of Florida, Gainesville, Florida
| | - Carolina B Maciel
- Department of Neurology, University of Florida, Gainesville, Florida
| | - Suzette LaRoche
- Department of Neurology, University of North Carolina, Chapel Hill, North Carolina
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Saceleanu VM, Toader C, Ples H, Covache-Busuioc RA, Costin HP, Bratu BG, Dumitrascu DI, Bordeianu A, Corlatescu AD, Ciurea AV. Integrative Approaches in Acute Ischemic Stroke: From Symptom Recognition to Future Innovations. Biomedicines 2023; 11:2617. [PMID: 37892991 PMCID: PMC10604797 DOI: 10.3390/biomedicines11102617] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/21/2023] [Accepted: 09/21/2023] [Indexed: 10/29/2023] Open
Abstract
Among the high prevalence of cerebrovascular diseases nowadays, acute ischemic stroke stands out, representing a significant worldwide health issue with important socio-economic implications. Prompt diagnosis and intervention are important milestones for the management of this multifaceted pathology, making understanding the various stroke-onset symptoms crucial. A key role in acute ischemic stroke management is emphasizing the essential role of a multi-disciplinary team, therefore, increasing the efficiency of recognition and treatment. Neuroimaging and neuroradiology have evolved dramatically over the years, with multiple approaches that provide a higher understanding of the morphological aspects as well as timely recognition of cerebral artery occlusions for effective therapy planning. Regarding the treatment matter, the pharmacological approach, particularly fibrinolytic therapy, has its merits and challenges. Endovascular thrombectomy, a game-changer in stroke management, has witnessed significant advances, with technologies like stent retrievers and aspiration catheters playing pivotal roles. For select patients, combining pharmacological and endovascular strategies offers evidence-backed benefits. The aim of our comprehensive study on acute ischemic stroke is to efficiently compare the current therapies, recognize novel possibilities from the literature, and describe the state of the art in the interdisciplinary approach to acute ischemic stroke. As we aspire for holistic patient management, the emphasis is not just on medical intervention but also on physical therapy, mental health, and community engagement. The future holds promising innovations, with artificial intelligence poised to reshape stroke diagnostics and treatments. Bridging the gap between groundbreaking research and clinical practice remains a challenge, urging continuous collaboration and research.
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Affiliation(s)
- Vicentiu Mircea Saceleanu
- Neurosurgery Department, Sibiu County Emergency Hospital, 550245 Sibiu, Romania;
- Neurosurgery Department, “Lucian Blaga” University of Medicine, 550024 Sibiu, Romania
| | - Corneliu Toader
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
- Department of Vascular Neurosurgery, National Institute of Neurology and Neurovascular Diseases, 020022 Bucharest, Romania
| | - Horia Ples
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), “Victor Babes” University of Medicine and Pharmacy, 300736 Timisoara, Romania
- Department of Neurosurgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Razvan-Adrian Covache-Busuioc
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
| | - Horia Petre Costin
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
| | - Bogdan-Gabriel Bratu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
| | - David-Ioan Dumitrascu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
| | - Andrei Bordeianu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
| | - Antonio Daniel Corlatescu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
| | - Alexandru Vlad Ciurea
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
- Neurosurgery Department, Sanador Clinical Hospital, 010991 Bucharest, Romania
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Wu Y, Li Z, Qu R, Wang Y, Li Z, Wang L, Zhao G, Feng K, Cheng Y, Yin S. Electroencephalogram-Based Brain Connectivity Analysis in Prolonged Disorders of Consciousness. Neural Plast 2023; 2023:4142053. [PMID: 37113750 PMCID: PMC10129427 DOI: 10.1155/2023/4142053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/03/2023] [Accepted: 04/02/2023] [Indexed: 04/29/2023] Open
Abstract
Background Prolonged disorders of consciousness (pDOC) are common in neurology and place a heavy burden on families and society. This study is aimed at investigating the characteristics of brain connectivity in patients with pDOC based on quantitative EEG (qEEG) and extending a new direction for the evaluation of pDOC. Methods Participants were divided into a control group (CG) and a DOC group by the presence or absence of pDOC. Participants underwent magnetic resonance imaging (MRI) T1 three-dimensional magnetization with a prepared rapid acquisition gradient echo (3D-T1-MPRAGE) sequence, and video EEG data were collected. After calculating the power spectrum by EEG data analysis tool, DTABR ((δ + θ)/(α + β) ratio), Pearson's correlation coefficient (Pearson r), Granger's causality, and phase transfer entropy (PTE), we performed statistical analysis between two groups. Finally, receiver operating characteristic (ROC) curves of connectivity metrics were made. Results The proportion of power in frontal, central, parietal, and temporal regions in the DOC group was lower than that in the CG. The percentage of delta power in the DOC group was significantly higher than that in the CG, the DTABR in the DOC group was higher than that in the CG, and the value was inverted. The Pearson r of the DOC group was higher than that of CG. The Pearson r of the delta band (Z = -6.71, P < 0.01), theta band (Z = -15.06, P < 0.01), and alpha band (Z = -28.45, P < 0.01) were statistically significant. Granger causality showed that the intensity of directed connections between the two hemispheres in the DOC group at the same threshold was significantly reduced (Z = -82.43, P < 0.01). The PTE of each frequency band in the DOC group was lower than that in the CG. The PTE of the delta band (Z = -42.68, P < 0.01), theta band (Z = -56.79, P < 0.01), the alpha band (Z = -35.11, P < 0.01), and beta band (Z = -63.74, P < 0.01) had statistical significance. Conclusion Brain connectivity analysis based on EEG has the advantages of being noninvasive, convenient, and bedside. The Pearson r of DTABR, delta, theta, and alpha bands, Granger's causality, and PTE of the delta, theta, alpha, and beta bands can be used as biological markers to distinguish between pDOC and healthy people, especially when behavior evaluation is difficult or ambiguous; it can supplement clinical diagnosis.
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Affiliation(s)
- Yuzhang Wu
- Clinical College of Neurology, Neurosurgery, and Neurorehabilitation, Tianjin Medical University, Tianjin 300000, China
| | - Zhitao Li
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin 300000, China
| | - Ruowei Qu
- State Key Laboratory of Reliability and Intelligence of Electrical Equipment, Hebei University of Technology, Tianjin 300000, China
| | - Yangang Wang
- Clinical College of Neurology, Neurosurgery, and Neurorehabilitation, Tianjin Medical University, Tianjin 300000, China
| | - Zhongzhen Li
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin 300000, China
| | - Le Wang
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin 300000, China
| | - Guangrui Zhao
- Clinical College of Neurology, Neurosurgery, and Neurorehabilitation, Tianjin Medical University, Tianjin 300000, China
| | - Keke Feng
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin 300000, China
| | - Yifeng Cheng
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin 300000, China
| | - Shaoya Yin
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin 300000, China
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Islam MS, Hussain I, Rahman MM, Park SJ, Hossain MA. Explainable Artificial Intelligence Model for Stroke Prediction Using EEG Signal. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22249859. [PMID: 36560227 PMCID: PMC9782764 DOI: 10.3390/s22249859] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/30/2022] [Accepted: 12/14/2022] [Indexed: 05/07/2023]
Abstract
State-of-the-art healthcare technologies are incorporating advanced Artificial Intelligence (AI) models, allowing for rapid and easy disease diagnosis. However, most AI models are considered "black boxes," because there is no explanation for the decisions made by these models. Users may find it challenging to comprehend and interpret the results. Explainable AI (XAI) can explain the machine learning (ML) outputs and contribution of features in disease prediction models. Electroencephalography (EEG) is a potential predictive tool for understanding cortical impairment caused by an ischemic stroke and can be utilized for acute stroke prediction, neurologic prognosis, and post-stroke treatment. This study aims to utilize ML models to classify the ischemic stroke group and the healthy control group for acute stroke prediction in active states. Moreover, XAI tools (Eli5 and LIME) were utilized to explain the behavior of the model and determine the significant features that contribute to stroke prediction models. In this work, we studied 48 patients admitted to a hospital with acute ischemic stroke and 75 healthy adults who had no history of identified other neurological illnesses. EEG was obtained within three months following the onset of ischemic stroke symptoms using frontal, central, temporal, and occipital cortical electrodes (Fz, C1, T7, Oz). EEG data were collected in an active state (walking, working, and reading tasks). In the results of the ML approach, the Adaptive Gradient Boosting models showed around 80% accuracy for the classification of the control group and the stroke group. Eli5 and LIME were utilized to explain the behavior of the stroke prediction model and interpret the model locally around the prediction. The Eli5 and LIME interpretable models emphasized the spectral delta and theta features as local contributors to stroke prediction. From the findings of this explainable AI research, it is expected that the stroke-prediction XAI model will help with post-stroke treatment and recovery, as well as help healthcare professionals, make their diagnostic decisions more explainable.
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Affiliation(s)
- Mohammed Saidul Islam
- Network and Data Analysis Group, Department of Computer Science and Engineering, Islamic University and Technology (IUT), Gazipur 1704, Bangladesh
| | - Iqram Hussain
- Department of Biomedical Engineering, Medical Research Center, College of Medicine, Seoul National University, Seoul 03080, Republic of Korea
- Data Mind Ltd., Dhaka 1230, Bangladesh
- Correspondence: or (I.H.); (M.A.H.)
| | - Md Mezbaur Rahman
- Network and Data Analysis Group, Department of Computer Science and Engineering, Islamic University and Technology (IUT), Gazipur 1704, Bangladesh
| | - Se Jin Park
- AI-Based Healthcare Research Group, Sewon Intelligence Ltd., Seoul 04512, Republic of Korea
| | - Md Azam Hossain
- Network and Data Analysis Group, Department of Computer Science and Engineering, Islamic University and Technology (IUT), Gazipur 1704, Bangladesh
- Correspondence: or (I.H.); (M.A.H.)
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9
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Williams Roberson S, Azeez NA, Taneja R, Pun BT, Pandharipande PP, Jackson JC, Ely EW. Quantitative EEG During Critical Illness Correlates with Patterns of Long-Term Cognitive Impairment. Clin EEG Neurosci 2022; 53:435-442. [PMID: 33289394 PMCID: PMC8561666 DOI: 10.1177/1550059420978009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Many intensive care unit (ICU) survivors suffer disabling long-term cognitive impairment (LTCI) after critical illness. We compared EEG characteristics during critical illness with patients' 1-year neuropsychological outcomes. METHODS We performed a post hoc analysis of patients in the BRAIN-ICU study who had undergone EEG for clinical purposes during admission (n = 10). All survivors underwent formal cognitive assessments at 12-month follow-up. We evaluated EEGs by conventional visual inspection and computed 10 quantitative features. We explored associations between EEG and patterns of LTCI using Wilcoxon rank-sum tests and Spearman's rank correlations. RESULTS Of 521 Vanderbilt patients enrolled in the parent study, 24 had EEG recordings during admission. Ten survivors had EEG tracings available and completed follow-up cognitive testing. All but one inpatient EEG showed generalized background slowing. All patients demonstrated cognitive impairment in at least one domain at follow-up. The most common deficits occurred in delayed memory (DM-median index 62) and visuospatial/constructional (VC-median index 69) domains. Relative alpha power correlated with VC score (ρ = 0.78, P = .008). Peak interhemispheric coherence correlated negatively with DM (ρ = -0.81, P = .018). CONCLUSIONS Quantitative EEG features during critical illness correlated with domain-specific cognitive performance in our small cohort of ICU survivors. Further study in larger prospective cohorts is required to determine whether these relationships hold. SIGNIFICANCE EEG may serve as a prognostic biomarker predicting patterns of long-term cognitive impairment.
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Affiliation(s)
- Shawniqua Williams Roberson
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA.,Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Naureen Abdul Azeez
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.,Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Randip Taneja
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brenda T Pun
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Pratik P Pandharipande
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Division of Critical Care, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - James C Jackson
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - E Wesley Ely
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Geriatric Research, Education and Clinical Center (GRECC) Service, Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, TN, USA
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10
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Sáez-Landete I, Gómez-Domínguez A, Estrella-León B, Díaz-Cid A, Fedirchyk O, Escribano-Muñoz M, Pedrera-Mazarro A, Martín-Palomeque G, Garcia-Ribas G, Rodríguez-Jorge F, Santos-Pérez G, Lourido-García D, Regidor-BaillyBailliere I. Retrospective Analysis of EEG in Patients With COVID-19: EEG Recording in Acute and Follow-up Phases. Clin EEG Neurosci 2022; 53:215-228. [PMID: 34319186 PMCID: PMC8958306 DOI: 10.1177/15500594211035923] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background. Interest in electroencephalographic (EEG) coronavirus disease 2019 (COVID-19) findings has been growing, especially in the search for a specific-features EEG of encephalopathy. Methods. We made a retrospective analysis of 29 EEGs recorded in 15 patients with COVID-19 and neurological symptoms. We classified the EEGs as "Acute EEG" and "follow-up EEG." We did a statistical analysis between voltage and respiratory status of the patient, stay or not in the intensive care unit (ICU), days of stay in the ICU, sedative drugs, pharmacological treatment, type of symptoms predominating, and outcome. Results. We found EEG abnormalities in all patients studied. We observed the amplitude of background <20 µV at 93% of "acute EEG," versus only 21.4% of "follow-up EEG." The average voltage went from 12.33 ± 5.09 µV in the acute EEGs to 32.8 ± 20.13 µV in the follow-up EEGs. A total of 60% of acute EEGs showed an intermittent focal rhythmic. We have not found a statistically significant association between voltage of acute EEG and nonneurological clinical status (including respiratory) that may interfere with the EEG findings. Conclusions. Nonspecific diffuse slowing EEG pattern in COVID-19 is the most common finding reported, but we found in addition to that, as a distinctive finding, low voltage EEG, that could explain the low prevalence of epileptic activity published in these patients. A metabolic/hypoxic mechanism seems unlikely on the basis of our EEG findings. This pattern in other etiologies is reminiscent of severe encephalopathy states associated with poor prognosis. However, an unreactive low voltage pattern in COVID-19 patients is not necessarily related to poor prognosis.
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Affiliation(s)
- Isabel Sáez-Landete
- 16507Department of Clinical Neurophysiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Adriana Gómez-Domínguez
- 16507Department of Clinical Neurophysiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Beatriz Estrella-León
- 16507Department of Clinical Neurophysiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Alba Díaz-Cid
- 16507Department of Clinical Neurophysiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Olga Fedirchyk
- 16507Department of Clinical Neurophysiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Marta Escribano-Muñoz
- 16507Department of Clinical Neurophysiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Antonio Pedrera-Mazarro
- 16507Department of Clinical Neurophysiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | | | - Gloria Santos-Pérez
- 16507Departament of Anesthesiology. Hospital Universitario Ramón y Cajal, Madrid
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11
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Guo X, Zhang X, Sun M, Yu L, Qian C, Zhang J, Xu W, Xie Y, Xu T, Jin Z. Modulation of Brain Rhythm Oscillations by Xingnao Kaiqiao Acupuncture Correlates with Stroke Recovery: A Randomized Control Trial. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2022; 28:436-444. [PMID: 35275751 DOI: 10.1089/jicm.2021.0264] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objectives: In China, Xingnao Kaiqiao (XNKQ) acupuncture has been widely used for stroke treatment. However, its electrophysiological mechanism remains unclear. Hence, this study aims to study how XNKQ acupuncture modulates brain rhythm oscillations of stroke patients, and investigate its correlation with stroke recovery. Design: Randomized control trial. Subjects: Twenty (sub)acute ischemic stroke patients were enrolled and randomly assigned to two groups (an acupuncture group [AG] [n = 10] and a control group [CG] [n = 10]), and four patients (two patients in each group) dropped out of the study. Interventions: All patients received conventional treatments, and the patients in AG received additional XNKQ acupuncture treatment once a day for 10 consecutive days. Outcome measures: Before treatment, 14 days after, and 30 days after treatment onset, their movement impairments and neurologic deficits were measured using the National Institute of Health Stroke Scale (NIHSS), the Fugl-Meyer (FM) Scale, the Modified Rankin Scale (mRS), and the Modified Barthel Index (MBI), and their electroencephalogram data were recorded. Results: Compared with the CG, the AG showed more improvement in FM scores (p = 0.02), as well as decreased relative delta power and increased relative alpha power after 2 weeks' treatment. The decrease of the relative delta power and the increase of the relative alpha power in the ipsilesional frontal area were significantly correlated with the FM improvement (F5, F7, FC1, and Fz electrodes, all |r| > 0.517, p < 0.040). Conclusions: The curative effect of XNKQ acupuncture related to its electrophysiological modulation. This study was registered at the Chinese Clinical Trial Registry (ChiCTR2000038560).
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Affiliation(s)
- Xiaoli Guo
- The School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | | | - Meng Sun
- Shanghai Minhang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China
| | - Lingxiao Yu
- The School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Chuan Qian
- Shanghai Minhang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China
| | - Jidan Zhang
- Wujing Community Health Service Center, Shanghai, China
| | - Wenli Xu
- Shanghai Minhang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China
| | - Yu Xie
- Shanghai Minhang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China
| | - Tao Xu
- Department of Anesthesiology, Affiliated Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zheng Jin
- Shanghai Minhang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China
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12
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Ohno A, Okumura A, Fukasawa T, Nakata T, Suzuki M, Tanaka M, Okai Y, Ito Y, Yamamoto H, Tsuji T, Kidokoro H, Saitoh S, Natsume J. Acute encephalopathy with biphasic seizures and late reduced diffusion: Predictive EEG findings. Brain Dev 2022; 44:221-228. [PMID: 34876315 DOI: 10.1016/j.braindev.2021.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 10/29/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) is a common type of acute encephalopathy in Japan; the condition is clinically characterized by prolonged seizures as the initial neurological symptom, followed by late seizures 4-6 days later. It is difficult to differentiate AESD from prolonged febrile seizures (PFSs). Here, we explored the use of electroencephalography to differentiate AESD from PFSs. METHODS We studied the electroencephalograms (EEGs) of children <6 years of age diagnosed with AESD or PFSs; all EEGs were recorded within 48 h of seizure onset (i.e., before the late seizures of AESD). Two pediatric neurologists evaluated all EEGs, focusing on the basic rhythm, slowing during wakefulness/arousal by stimuli, spindles, fast waves, and slowing during sleep. RESULTS The EEGs of 14 children with AESD and 31 children with PFSs were evaluated. Spindles were more commonly reduced or absent in children with AESD than in those with PFSs (71% vs. 31%, p = 0.021). Fast waves were also more commonly reduced or absent in children with AESD (21% vs. 0%, p = 0.030). The rates of all types of slowing did not differ between children with AESD and those with PFSs, but continuous or frequent slowing during sleep was more common in the former (50% vs. 17%, p = 0.035). CONCLUSIONS EEG findings may usefully differentiate AESD from PFSs. Reduced or absent spindles/fast waves and continuous or frequent slowing during sleep are suggestive of AESD in children with prolonged seizures associated with fever.
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Affiliation(s)
- Atsuko Ohno
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Aichi, Japan.
| | - Akihisa Okumura
- Department of Pediatrics, Aichi Medical University, Aichi, Japan
| | | | - Tomohiko Nakata
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Motomasa Suzuki
- Department of Pediatric Neurology, Aichi Children's Health and Medical Center, Aichi, Japan
| | - Masaharu Tanaka
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Yu Okai
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Yuji Ito
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Hiroyuki Yamamoto
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Takeshi Tsuji
- Department of Pediatrics, Okazaki City Hospital, Aichi, Japan
| | - Hiroyuki Kidokoro
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Shinji Saitoh
- Department of Pediatric and Neonatology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Jun Natsume
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Aichi, Japan
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13
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Abbasy M, Zaghla H, Elhelbawy M, Ramadan M, Zakareya T. Predicting in-hospital mortality of cirrhotic patients hospitalized with hepatic encephalopathy. EGYPTIAN LIVER JOURNAL 2022. [DOI: 10.1186/s43066-022-00178-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Abstract
Background
Hepatic encephalopathy (HE) is a serious condition associated with high rates of mortality. Many scoring systems are used to predict the outcome of HE in patients admitted to the intensive care unit (ICU). The most used scores are Child-Turcotte-Pugh (CTP), Model for End-stage Liver Disease (MELD), Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA), and Acute Physiology and Chronic Health Evaluation II (APACHE II). These scores were thoroughly investigated in HE associated with acute liver failure (type A). In the present study, we aimed to evaluate the prognostic value of these scores in patients with HE on a background of liver cirrhosis (type C). Two hundred cirrhotic patients hospitalized with HE were included in the study. Diagnosis and classification of HE were based on the West Haven criteria. APACHE II, CLIF-SOFA, MELD, MELD-Na, and CTP scores were calculated for all patients within the first 24 h after admission. According to survival outcomes, patients were categorized into either improved or deceased. Demographic, clinical, and laboratory data as well as prognostic scores were compared in both deceased and improved groups. The receiver operating characteristic (ROC) curve was plotted, and the area under the ROC curve (AUROC) was calculated for each score. Backward logistic regression analysis was used to identify the predictors of mortality.
Results
60.5% of patients were males. The mean age was 61.09 ± 8.94 years. The main precipitating factors of HE was infections predominantly spontaneous bacterial peritonitis (n = 108, 54.0%) followed by variceal bleeding (n = 39, 19.5%). All scores were significantly higher in the deceased patients. AUROC were 0.734 (CI95% 0.666–0.803), 0.717 (CI95% 0.647–0.787), 0.663 (CI95% 0.589–0.738), 0.626 (CI95% 0.549–0.704), and 0.609 (CI95% 0.531–0.686) for CLIF-SOFA, MELD-Na, MELD, APACHE II, and CTP scores, respectively. MELD, MELD-Na, and CLIF-SOFA scores were the independent predictors of mortality. Among these scores, CLIF-SOFA was the strongest independent predictor of mortality (OR = 1.142, CI95% = 0.888–1.467, p = 0.001).
Conclusions
CLIF-SOFA score was superior to other prognostic scores in predicting mortality in hospitalized patients with HE type C.
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14
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Jatupornpoonsub T, Thimachai P, Supasyndh O, Wongsawat Y. Background Activity Findings in End-Stage Renal Disease With and Without Comorbid Diabetes: An Electroencephalogram Study. Front Hum Neurosci 2021; 15:741446. [PMID: 34690724 PMCID: PMC8531714 DOI: 10.3389/fnhum.2021.741446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/09/2021] [Indexed: 11/23/2022] Open
Abstract
Renal failure and diabetes can induce cerebral complications, including encephalopathy, for which attentional and cognitive impairment are common symptoms. It is possible that renal failure with comorbid diabetes may induce more severe encephalopathy due to multiple pathogenic mechanisms. This concept was supported by the main findings of this study, which showed that EEG background activity between end-stage renal disease with and without comorbid diabetes was significantly different in relative power of delta in the eyes-open condition in frontoparietal regions; theta in the eyes-closed condition in all regions; beta in the parieto-occipital regions in both eye conditions; the delta/theta ratio in both eye conditions in frontoparietal regions; and the theta/beta ratio in all regions in the eyes-closed condition. These findings may increase awareness of comorbid cerebral complications in clinical practice. Moreover, the delta/theta ratio is recommended as an optimal feature to possibly determine the severity of encephalopathy.
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Affiliation(s)
- Tirapoot Jatupornpoonsub
- Brain Computer Interface Laboratory, Department of Biomedical Engineering, Faculty of Engineering, Mahidol University, Salaya, Thailand
| | - Paramat Thimachai
- Nephrology Division, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand
| | - Ouppatham Supasyndh
- Nephrology Division, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand
| | - Yodchanan Wongsawat
- Brain Computer Interface Laboratory, Department of Biomedical Engineering, Faculty of Engineering, Mahidol University, Salaya, Thailand
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15
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Di Cerbo A, Roncati L, Marini C, Carnevale G, Zavatti M, Avallone R, Corsi L. Possible Association Between DHEA and PKCε in Hepatic Encephalopathy Amelioration: A Pilot Study. Front Vet Sci 2021; 8:695375. [PMID: 34651032 PMCID: PMC8505975 DOI: 10.3389/fvets.2021.695375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/25/2021] [Indexed: 12/18/2022] Open
Abstract
Objective: Hepatic encephalopathy (HE) is a neuropsychiatric syndrome caused by liver failure and by an impaired neurotransmission and neurological function caused by hyperammonemia (HA). HE, in turn, decreases the phosphorylation of protein kinase C epsilon (PKCε), contributing to the impairment of neuronal functions. Dehydroepiandrosterone (DHEA) exerts a neuroprotective effect by increasing the GABAergic tone through GABAA receptor stimulation. Therefore, we investigated the protective effect of DHEA in an animal model of HE, and the possible modulation of PKCε expression in different brain area. Methods: Fulminant hepatic failure was induced in 18 male, Sprague–Dawley rats by i.p. administration of 3 g/kg D-galactosamine, and after 30 min, a group of animals received a subcutaneous injection of 25 mg/kg (DHEA) repeated twice a day (3 days). Exploratory behavior and general activity were evaluated 24 h and 48 h after the treatments by the open field test. Then, brain cortex and cerebellum were used for immunoblotting analysis of PKCε level. Results: DHEA administration showed a significant improvement of locomotor activity both 24 and 48 h after D-galactosamine treatment (****p < 0.0001) but did not ameliorate liver parenchymal degeneration. Western blot analysis revealed a reduced immunoreactivity of PKCε (*p < 0.05) following D-galactosamine treatment in rat cortex and cerebellum. After the addition of DHEA, PKCε increased in the cortex in comparison with the D-galactosamine-treated (***p < 0.001) and control group (*p < 0.05), but decreased in the cerebellum (*p < 0.05) with respect to the control group. PKCε decreased after treatment with NH4Cl alone and in combination with DHEA in both cerebellum and cortex (****p < 0.0001). MTS assay demonstrated the synergistic neurotoxic action of NH4Cl and glutamate pretreatment in cerebellum and cortex along with an increased cell survival after DHEA pretreatment, which was significant only in the cerebellum (*p < 0.05). Conclusion: An association between the DHEA-mediated increase of PKCε expression and the improvement of comatose symptoms was observed. PKCε activation and expression in the brain could inhibit GABA-ergic tone counteracting HE symptoms. In addition, DHEA seemed to ameliorate the symptoms of HE and to increase the expression of PKCε in cortex and cerebellum.
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Affiliation(s)
- Alessandro Di Cerbo
- School of Biosciences and Veterinary Medicine, University of Camerino, Matelica, Italy
| | - Luca Roncati
- Institute of Pathology, University of Modena and Reggio Emilia, Modena, Italy
| | - Carlotta Marini
- School of Biosciences and Veterinary Medicine, University of Camerino, Matelica, Italy
| | - Gianluca Carnevale
- Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Manuela Zavatti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Rossella Avallone
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenzo Corsi
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy.,National Institute of Biostructure and Biosystems, Rome, Italy
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16
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Li Y, Miao Y, Yu M, Zhu Y, Liang Z, Wang Z, Peng Q. Case Report: PRES-Like Syndrome With Reversible Cortical Blindness Associated With Essential Thrombocythemia. Front Neurol 2021; 12:743165. [PMID: 34603193 PMCID: PMC8484312 DOI: 10.3389/fneur.2021.743165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 08/13/2021] [Indexed: 11/22/2022] Open
Abstract
Background: There are few reported cases of posterior reversible encephalopathy syndrome (PRES) combined with essential thrombocythemia (ET). We report a case of PRES-like syndrome in ET. Case Report: A 60-year-old man with a history of hypertension and thrombocythemia presented with progressive visual loss after waking up; and neurological examination showed pupils were 3 mm and equally reactive to light, which suggested cortical blindness. Brain magnetic resonance imaging (MRI) revealed restricted diffusion in diffusion-weighted imaging (DWI) in the bilateral parietal and occipital lobes. Routine blood tests revealed a platelet count of 1,044 × 109/L. ET was diagnosed after exclusion of other causes. Electroencephalography (EEG) showed periodic triphasic waves in the occipital region. The lesions of the parietal and occipital lobes on MRI and periodic triphasic waves of EEG disappeared quickly, and patient's vision returned to normal after the treatment with hydroxyurea and sodium bicarbonate. The patient experienced hallucinatory palinopsia during the recovery of vision. Conclusion: ET may be a risk factor for PRES.
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Affiliation(s)
- Ying Li
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Yuanfeng Miao
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Meng Yu
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Ying Zhu
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Zeyin Liang
- Department of Hematology, Peking University First Hospital, Beijing, China
| | - Zhaoxia Wang
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Qing Peng
- Department of Neurology, Peking University First Hospital, Beijing, China
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17
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De Stefano P, Carboni M, Marquis R, Spinelli L, Seeck M, Vulliemoz S. Increased delta power as a scalp marker of epileptic activity: a simultaneous scalp and intracranial electroencephalography study. Eur J Neurol 2021; 29:26-35. [PMID: 34528320 PMCID: PMC9293335 DOI: 10.1111/ene.15106] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/09/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE The purpose was to evaluate whether intracranial interictal epileptiform discharges (IEDs) that are not visible on the scalp are associated with changes in the frequency spectrum on scalp electroencephalograms (EEGs). METHODS Simultaneous scalp high-density EEG and intracranial EEG recordings were recorded in nine patients undergoing pre-surgical invasive recordings for pharmaco-resistant temporal lobe epilepsy. Epochs with hippocampal IED visible on intracranial EEG (ic-IED) but not on scalp EEG were selected, as well as control epochs without ic-IED. Welch's power spectral density was computed for each scalp electrode and for each subject; the power spectral density was further averaged across the canonical frequency bands and compared between the two conditions with and without ic-IED. For each patient the peak frequency in the delta band (the significantly strongest frequency band in all patients) was determined during periods of ic-IED. The five electrodes showing strongest power at the peak frequency were also determined. RESULTS It was found that intracranial IEDs are associated with an increase in delta power on scalp EEGs, in particular at a frequency ≥1.4 Hz. Electrodes showing slow frequency power changes associated with IEDs were consistent with the hemispheric lateralization of IEDs. Electrodes with maximum power of slow activity were not limited to temporal regions but also involved frontal (bilateral or unilateral) regions. CONCLUSIONS In patients with a clinical picture suggestive of temporal lobe epilepsy, the presence of delta slowing ≥1.4 Hz in anterior temporal regions can represent a scalp marker of hippocampal IEDs. To our best knowledge this is the first study that demonstrates the co-occurrence of ic-IED and increased delta power.
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Affiliation(s)
- Pia De Stefano
- EEG and Epilepsy Unit, Neurology Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Margherita Carboni
- EEG and Epilepsy Unit, Neurology Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Renaud Marquis
- EEG and Epilepsy Unit, Neurology Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Laurent Spinelli
- EEG and Epilepsy Unit, Neurology Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Margitta Seeck
- EEG and Epilepsy Unit, Neurology Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Serge Vulliemoz
- EEG and Epilepsy Unit, Neurology Department, University Hospitals of Geneva, Geneva, Switzerland
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18
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Freund B, Kotchetkov IS, Kaplan PW. White Matter Disease-The True Source of Triphasic Waves? J Clin Neurophysiol 2021; 38:359-361. [PMID: 34155178 DOI: 10.1097/wnp.0000000000000745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SUMMARY Triphasic waves are EEG phenomena typically seen in patients with acute encephalopathy and have importance in diagnosis and prognosis in these cases. The underlying metabolic disturbances associated with their incidence have been described previously, but neuroimaging characteristics are not well delineated. There are a few small studies that define neuroimaging results in patients with triphasic waves. This review highlights the most common neuroimaging findings in these patients, including subcortical white matter disease, which itself may be a risk factor for triphasic waves.
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Affiliation(s)
- Brin Freund
- Department of Neurology, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, U.S.A. ; and
| | - Ivan S Kotchetkov
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, U.S.A
| | - Peter W Kaplan
- Department of Neurology, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, U.S.A. ; and
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19
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Rahwan M, Edwards JC. Neuroimaging in Triphasic Waves. J Clin Neurophysiol 2021; 38:410-414. [PMID: 34155179 DOI: 10.1097/wnp.0000000000000778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SUMMARY Triphasic waves can be seen in a wide range of medical conditions, particularly in metabolic encephalopathies. Neuroimaging studies provide valuable diagnostic information for neurological conditions and can also help in our understanding of anatomical substrates for these conditions. Because of practical challenges and the fact that most encephalopathies with triphasic waves are presumed to be metabolic in etiology, large studies of imaging findings associated with triphasic waves are limited. We present a summary of studies that are currently available and a discussion of insights that these studies provide.
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Affiliation(s)
- Mohamad Rahwan
- Department of Neurology, The Medical University of South Carolina, Charleston, South Carolina, U.S.A
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Hussain I, Park SJ. Quantitative Evaluation of Task-Induced Neurological Outcome after Stroke. Brain Sci 2021; 11:brainsci11070900. [PMID: 34356134 PMCID: PMC8307254 DOI: 10.3390/brainsci11070900] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 11/16/2022] Open
Abstract
Electroencephalography (EEG) can access ischemic stroke-derived cortical impairment and is believed to be a prospective predictive method for acute stroke prognostics, neurological outcome, and post-stroke rehabilitation management. This study aims to quantify EEG features to understand task-induced neurological declines due to stroke and evaluate the biomarkers to distinguish the ischemic stroke group and the healthy adult group. We investigated forty-eight stroke patients (average age 72.2 years, 62% male) admitted to the rehabilitation center and seventy-five healthy adults (average age 77 years, 31% male) with no history of known neurological diseases. EEG was recorded through frontal, central, temporal, and occipital cortical electrodes (Fz, C1, C2, T7, T8, Oz) using wireless EEG devices and a newly developed data acquisition platform within three months after the appearance of symptoms of ischemic stroke (clinically confirmed). Continuous EEG data were recorded during the consecutive resting, motor (walking and working activities), and cognitive reading tasks. The statistical results showed that alpha, theta, and delta activities are biomarkers classifying the stroke patients and the healthy adults in the motor and cognitive states. DAR and DTR of the stroke group differed significantly from those of the healthy control group during the resting, motor, and cognitive tasks. Using the machine-learning approach, the C5.0 model showed 78% accuracy for the resting state, 89% accuracy in the functional motor walking condition, 84% accuracy in the working condition, and 85% accuracy in the cognitive reading state for classification the stroke group and the control group. This study is expected to be helpful for post-stroke treatment and post-stroke recovery.
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Affiliation(s)
- Iqram Hussain
- Center for Medical Convergence Metrology, Korea Research Institute of Standards and Science, Daejeon 34113, Korea;
- Department of KSB (Knowledge-Converged Super Brain) Convergence Research, Electronics and Telecommunication Research Institute, Daejeon 34129, Korea
- Department of Medical Physics, University of Science & Technology, Daejeon 34113, Korea
| | - Se-Jin Park
- Center for Medical Convergence Metrology, Korea Research Institute of Standards and Science, Daejeon 34113, Korea;
- Department of KSB (Knowledge-Converged Super Brain) Convergence Research, Electronics and Telecommunication Research Institute, Daejeon 34129, Korea
- Department of Medical Physics, University of Science & Technology, Daejeon 34113, Korea
- AI Research Group, Sewon Intelligence, Ltd., Seoul 04512, Korea
- Correspondence:
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Nazish S. Clinical and Radiological Correlates of Different Electroencephalographic Pattern in Hospitalized Patients. Clin EEG Neurosci 2021; 52:280-286. [PMID: 32141318 DOI: 10.1177/1550059420910559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective. The present study aimed to determine the clinical and radiological correlates of different electroencephalographic (EEG) patterns in hospitalized patients. Subjects and Methods. In this retrospective study performed at the Neurology Department, King Fahd University Hospital, Kingdom of Saudi Arabia (KSA), data of 374 patients who underwent EEG were reviewed and analyzed. Results. Presence of focal spike and wave or sharp wave (SW) (P = .00), generalized theta activity (P = .00), generalized delta activity (P = .04), persistent focal slow wave activity (SWA) (P = .003) and asymmetric background (P = .01) in the EEG record was significantly associated with abnormal imaging findings. Specifically, generalized theta delta activity (P = .01) and markedly attenuated EEG activity (P = .007) were associated with presence of cortical lesions; whereas, triphasic waves (TWs) (P = .009), and generalized theta activity (P = .001) were found to be related with presence of subcortical lesions. While, generalized delta activity (P = .01) was the only correlate with extra-axial lesions. Conclusion. At present, certain EEG patterns cannot be precisely correlated with imaging findings, suggesting that intercurrent metabolic, infectious, and/or toxic contributors could be the confounding factors. Nonetheless, when EEG patterns are examined alongside magnetic resonance imaging findings and other clinically relevant data, these might be indicative of a group of diseases in some pertinent situations. Thus, further larger prospective clinical studies that incorporate continuous EEG monitoring, advanced radiology techniques, and laboratory analyses would be beneficial to elucidate their interplay for better firm up the correlations.
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Affiliation(s)
- Saima Nazish
- Department of Neurology, College of Medicine, 48135Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Jelinčić V, Van Diest I, Torta DM, von Leupoldt A. The breathing brain: The potential of neural oscillations for the understanding of respiratory perception in health and disease. Psychophysiology 2021; 59:e13844. [PMID: 34009644 DOI: 10.1111/psyp.13844] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 11/30/2022]
Abstract
Dyspnea or breathlessness is a symptom occurring in multiple acute and chronic illnesses, however, the understanding of the neural mechanisms underlying its subjective experience is limited. In this topical review, we propose neural oscillatory dynamics and cross-frequency coupling as viable candidates for a neural mechanism underlying respiratory perception, and a technique warranting more attention in respiration research. With the evidence for the potential of neural oscillations in the study of normal and disordered breathing coming from disparate research fields with a limited history of interdisciplinary collaboration, the main objective of the review was to converge the existing research and suggest future directions. The existing findings show that distinct limbic and cortical activations, as measured by hemodynamic responses, underlie dyspnea, however, the time-scale of these activations is not well understood. The recent findings of oscillatory neural activity coupled with the respiratory rhythm could provide the solution to this problem, however, more research with a focus on dyspnea is needed. We also touch on the findings of distinct spectral patterns underlying the changes in breathing due to experimental manipulations, meditation and disease. Subsequently, we suggest general research directions and specific research designs to supplement the current knowledge using neural oscillation techniques. We argue for the benefits of interdisciplinary collaboration and the converging of neuroimaging and behavioral methods to best explain the emergence of the subjective and aversive individual experience of dyspnea.
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Affiliation(s)
- Valentina Jelinčić
- Research Group Health Psychology, Department of Psychology, KU Leuven, Leuven, Belgium
| | - Ilse Van Diest
- Research Group Health Psychology, Department of Psychology, KU Leuven, Leuven, Belgium
| | - Diana M Torta
- Research Group Health Psychology, Department of Psychology, KU Leuven, Leuven, Belgium
| | - Andreas von Leupoldt
- Research Group Health Psychology, Department of Psychology, KU Leuven, Leuven, Belgium
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Al-Ramadan A, Rabab’h O, Shah J, Gharaibeh A. Acute and Post-Acute Neurological Complications of COVID-19. Neurol Int 2021; 13:102-119. [PMID: 33803475 PMCID: PMC8006051 DOI: 10.3390/neurolint13010010] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/01/2021] [Accepted: 03/05/2021] [Indexed: 12/15/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is an emerging global health emergency caused by the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The global outbreak of SARS-CoV-2 infection has been declared a global pandemic by the World Health Organization (WHO). The clinical presentation of SARS-CoV-2 infection depends on the severity of the disease and may range from an asymptomatic infection to a severe and lethal illness. Fever, cough, and shortness of breath are among the most common symptoms associated with SARS-CoV-2 infection. Accumulating evidence indicates that COVID-19 patients commonly develop neurological symptoms, such as headache, altered mental status, anosmia, and myalgia. In this comprehensive literature review, we have summarized the most common neurological complications and reported neurological case studies associated with COVID-19, and neurological side effects associated with COVID-19 treatments. Additionally, the post-acute COVID-19 syndrome and long-term neurological complications were discussed. We also explained the proposed mechanisms that are involved in the pathogenesis of these neurological complications.
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Affiliation(s)
- Ali Al-Ramadan
- Insight Research Institute, Flint, MI 48507, USA; (A.A.-R.); (O.R.); (J.S.)
- Center for Cognition and Neuroethics, University of Michigan-Flint, Flint, MI 48502, USA
| | - Omar Rabab’h
- Insight Research Institute, Flint, MI 48507, USA; (A.A.-R.); (O.R.); (J.S.)
- Center for Cognition and Neuroethics, University of Michigan-Flint, Flint, MI 48502, USA
| | - Jawad Shah
- Insight Research Institute, Flint, MI 48507, USA; (A.A.-R.); (O.R.); (J.S.)
- Center for Cognition and Neuroethics, University of Michigan-Flint, Flint, MI 48502, USA
- Insight Research Center, Insight Institute of Neurosurgery & Neuroscience, Flint, MI 48507, USA
- Department of Medicine, Michigan State University, East Lansing, MI 48824, USA
- Insight Surgical Hospital, Warren, MI 48091, USA
| | - Abeer Gharaibeh
- Insight Research Institute, Flint, MI 48507, USA; (A.A.-R.); (O.R.); (J.S.)
- Center for Cognition and Neuroethics, University of Michigan-Flint, Flint, MI 48502, USA
- Insight Research Center, Insight Institute of Neurosurgery & Neuroscience, Flint, MI 48507, USA
- Insight Surgical Hospital, Warren, MI 48091, USA
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Abstract
Sepsis-associated encephalopathy (SAE) is the term used to define brain dysfunction related to infections that are principally located outside the central nervous system (CNS). A number of published studies report that electroencephalography (EEG) has been used in the evaluation of patients with sepsis, alone or usually in combination, to evoked potentials and neuroimaging. This was in an effort to assess if EEG can be a tool in the diagnosis and monitoring of the neurological status in sepsis patients. Although there is no specific test for the diagnosis and prognosis of sepsis related encephalopathy, our literature review suggests that EEG has a role in the assessment of this clinical entity. Due to its low cost and simplicity in its performance, EEG could be a potential aid in the assessment of sepsis neurological complications even in the early, subclinical stages of the syndrome. The aim of this review is to summarize the published literature regarding the application and utility of electroencephalography in adult patients with sepsis.
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Abstract
PURPOSE Triphasic waves (TWs), a common EEG pattern, are considered a subtype of generalized periodic discharges. Most patients with TWs present with an altered level of consciousness, and the TW pattern is believed to represent thalamocortical dysfunction. However, the exact meaning and mechanism of TWs remain unclear. The objective of the current study was to evaluate the source of TWs using EEG source imaging and computerized tomography. METHODS Twenty-eight patients with TWs were investigated. Source analysis was performed on the averaged TWs for each individual, and source maps were extracted. Normalization and automatic segmentation of gray matter were performed on computerized tomography scans before analysis. Finally, voxelwise correlation analyses were conducted between EEG source maps and gray matter volumes. RESULTS Source analyses showed that the anterior cingulate cortex was mainly involved in TWs (16/28 patients, 57%). Correlation analyses showed moderate positive and negative correlations between source location and gray matter volumes for the posterior cingulate (T = 2.85; volume = 6,533 mm3; r = 0.53; P = 0.002) and the superior frontal gyrus (T = 2.54; volume = 18,167 mm3; r = -0.48; P < 0.0001), respectively. CONCLUSIONS The results suggest that the anterior cingulate is involved in the origin of TWs. Furthermore, the volumes of posterior brain regions were positively correlated with TWs, indicating a possible preservation of these structures. Conversely, the volumes of anterior regions were negatively correlated with TWs. These findings may indicate a structural pattern necessary for the generation of the abnormal network responsible for TWs.
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The Prevalence, Predictors, and In-Hospital Mortality of Hepatic Encephalopathy in Patients with Liver Cirrhosis Admitted at St. Dominic Hospital in Akwatia, Ghana. Can J Gastroenterol Hepatol 2020; 2020:8816522. [PMID: 33425806 PMCID: PMC7772042 DOI: 10.1155/2020/8816522] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Hepatic encephalopathy (HE) is one of the most debilitating complications of cirrhosis leading to death. Decrease in HE mortality and recurrence has been linked with timely identification and early treatment. There is a need to document the burden, predictors, and treatment outcomes of HE in an adult population with liver cirrhosis in our setting as only reports from resource-endowed countries abound in the literature. This study aimed therefore to determine the prevalence, predictors, and treatment outcomes of patients with liver cirrhosis admitted at St. Dominic Hospital (SDH) in Akwatia, Ghana. MATERIALS AND METHODS A prospective study was conducted involving one hundred and sixty-seven (167) patients admitted at the medical wards in SDH with liver cirrhosis from January 1st, 2018, to March 24th, 2020. The demographic and clinical features of the patients were collected using a standardized questionnaire. Biochemical, haematological, and abdominal ultrasound scans were done for all patients. Patients were then followed up until discharge or death. RESULTS There were 109 (65.3%) males out of the 167 patients with a mean age of 45.8 and 47.5 years for those with and without HE, respectively. The prevalence of HE was 31.7% (53/167). Out of 53 participants with HE, 75.5% (40/53) died. There was a strong association between HE and death (p < 0.001). The major precipitating factor of HE was infection (64.2%). Severe ascites (OR = 0.009) were clinical feature independently associated with HE, whereas high creatinine (OR = 0.987), blood urea nitrogen (BUN) (OR = 1.199), Child-Pugh score (CPS) (OR = 5.899), and low platelets (OR = 0.992) were the laboratory parameters and scores independently predictive of HE. CONCLUSION HE was common among patients with liver cirrhosis admitted at SDH with high in-patient mortality. The commonest precipitating factor for HE was infection(s). Severe ascites, low platelet count, high creatinine, BUN, and CPS were independent predictors of HE.
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[Neurological complications attributable to lithium: An update]. Rev Med Interne 2020; 42:120-126. [PMID: 33203541 DOI: 10.1016/j.revmed.2020.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 07/15/2020] [Accepted: 08/03/2020] [Indexed: 12/24/2022]
Abstract
Lithium intoxication may induce neurological complications, initially characterised by a conscience alteration and an encephalopathy clinical picture with a risk of death or sever long-term consequences. With an occurrence sometimes atypical and possibly without initial hyperlitemia, the diagnosis delay of these complications might be important. Moreover, no specific guidelines focused on these complications are available. The aim of this article is to propose an update on diagnosis and treatment of neurological complications attributable to lithium, as encephalopathy.
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Sechi E, Zekeridou A. Neurologic Complications of Immune Checkpoint Inhibitors in Thoracic Malignancies. J Thorac Oncol 2020; 16:381-394. [PMID: 33188910 DOI: 10.1016/j.jtho.2020.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/30/2020] [Accepted: 11/05/2020] [Indexed: 01/08/2023]
Abstract
Immune checkpoint inhibitors (ICIs) have transformed the prognosis of cancers previously considered lethal. The spectrum of therapeutic indications is rapidly expanding, including the vast majority of thoracic malignancies. By enhancing the immune responses against cancer, the ICI treatments lead to the development of immune-related adverse events (irAEs) that may affect any organ. Severity varies from mild to fatal clinical manifestations. Neurologic involvement is relatively rare and highly heterogeneous, including central and peripheral nervous system diseases associated with neural-specific autoantibodies or not, central nervous system vasculitis, and granulomatous and demyelinating disorders. Symptoms often manifest within the first four cycles of treatment and can develop regardless of the class of ICI used. An unfavorable outcome is found in up to one-third of patients and is generally associated with the patients' clinical characteristics (e.g., age, coexistence of systemic adverse events), cancer type (e.g., lung cancer versus other), and specific clinical setting (e.g., ICI treatment in patients with preexisting paraneoplastic neurologic autoimmunity, ICI rechallenge after a first neurologic irAE). Diagnosis should be suspected in patients with new-onset neurologic symptoms while on ICI treatment which are not explained by metastatic disease or other metabolic/infectious disorders. Recommended treatment is based on clinical severity and consists of ICI discontinuation with or without immunosuppressive/immunomodulatory therapy, although alternative approaches are reasonable depending on cancer status (e.g., aggressive immunosuppression without discontinuing ICI in patients with initial cancer response). Early recognition and appropriate treatment of these neurologic irAEs are crucial for improved patient outcomes and therapeutic planning.
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Affiliation(s)
- Elia Sechi
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Anastasia Zekeridou
- Department of Neurology, Mayo Clinic, Rochester, Minnesota; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.
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Hoshi H, Shigihara Y. Age- and gender-specific characteristics of the resting-state brain activity: a magnetoencephalography study. Aging (Albany NY) 2020; 12:21613-21637. [PMID: 33147568 PMCID: PMC7695396 DOI: 10.18632/aging.103956] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 08/01/2020] [Indexed: 12/29/2022]
Abstract
Aging and gender influence regional brain activities. Although these biases should be considered during the clinical examinations using magnetoencephalography, they have yet to be standardized. In the present study, resting-state magnetoencephalography data were recorded from 54 healthy females and 48 males aged 22 to 75 years, who were controlled for cognitive performance. The regional oscillatory power was estimated for each frequency band (delta, theta, alpha, beta, low-gamma, and high-gamma) using the sLORETA-like algorithm and the biases of age and gender were evaluated, respectively. The results showed that faster oscillatory powers increased with age in the rostral regions and decreased in the caudal regions, while few slower oscillatory powers changed with age. Gender differences in oscillatory powers were found in a broad frequency range, mostly in the caudal brain regions. The present study characterized the effects of healthy aging and gender asymmetricity on the regional resting-state brain activity, with the aim to facilitate the accurate and efficient use of magnetoencephalography in clinical practice.
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Affiliation(s)
- Hideyuki Hoshi
- Precision Medicine Centre, Hokuto Hospital, Obihiro-shi, Hokkaido, Japan
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Alkhamis F, Nazish S. Electroencephalographic Grading of Neuronal Dysfunction in Various Etiologies of Encephalopathy. Clin EEG Neurosci 2020; 51:420-425. [PMID: 32483980 DOI: 10.1177/1550059420925962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The objective of this work was to study the electroencephalographic (EEG) grading of neuronal dysfunction in encephalopathy of various etiologies and assess their association with clinical outcomes. SUBJECTS AND METHODS This retrospective cross-sectional study was performed between June and November 2018 at the Neurology Department of King Fahd Hospital of University, Kingdom of Saudi Arabia (KSA) and involved a review and analysis of EEG and medical records pertaining to 222 patients in whom encephalopathy was diagnosed. RESULTS In patients suffering from encephalopathy, advanced age (P = .01), low Glasgow Coma Scale (GCS) scores (P = .00), and certain etiologies, namely hypoxic-ischemic encephalopathy (HIE) (P = .00), septic encephalopathy (P = .01), and other illnesses (P = .00), were significantly associated with unfavorable clinical outcomes, whereas traumatic brain injury (TBI) (P = .01) and GCS >7 (P = .00) were associated with favorable outcomes. Among different etiologies, EEG grade I (P = .02) and grade IV (P = .04) neuronal dysfunction was significantly associated with TBI while grade III (P = .05) and grade V (P = .02) neuronal dysfunction was significantly associated with HIE. Grade I (P = .03) neuronal dysfunction was mostly observed in septic encephalopathy cases, while patients suffering from other illnesses were also found to have grade I (P = .04) and grade IV (P = .05) neuronal dysfunction based on their EEG. CONCLUSION EEG is being conducted routinely to determine the course and severity of various forms of encephalopathy. However, the clinical implications of EEG grading for neuronal dysfunction are largely dependent on underlying etiology and other clinical parameters, such as age and GCS score. Further larger prospective cohort studies involving other important prognostic parameters and continuous EEG monitoring are thus needed.
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Affiliation(s)
- Fahad Alkhamis
- Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Saima Nazish
- Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Gélisse P, Rossetti AO, Genton P, Crespel A, Kaplan PW. How to carry out and interpret EEG recordings in COVID-19 patients in ICU? Clin Neurophysiol 2020; 131:2023-2031. [PMID: 32405259 PMCID: PMC7217782 DOI: 10.1016/j.clinph.2020.05.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 01/05/2023]
Abstract
There are questions and challenges regarding neurologic complications in COVID-19 patients. EEG is a safe and efficient tool for the evaluation of brain function, even in the context of COVID-19. However, EEG technologists should not be put in danger if obtaining an EEG does not significantly advance diagnosis or change management in the patient. Not every neurologic problem stems from a primary brain injury: confusion, impaired consciousness that evolves to stupor and coma, and headaches are frequent in hypercapnic/hypoxic encephalopathies. In patients with chronic pulmonary disorders, acute symptomatic seizures have been reported in acute respiratory failure in 6%. The clinician should be aware of the various EEG patterns in hypercapnic/hypoxic and anoxic (post-cardiac arrest syndrome) encephalopathies as well as encephalitides. In this emerging pandemic of infectious disease, reduced EEG montages using single-use subdermal EEG needle electrodes may be used in comatose patients. A full 10-20 EEG complement of electrodes with an ECG derivation remains the standard. Under COVID-19 conditions, an expedited study that adequately screens for generalized status epilepticus, most types of regional status epilepticus, encephalopathy or sleep may serve for most clinical questions, using simplified montages may limit the risk of infection to EEG technologists. We recommend noting whether the patient is undergoing or has been placed prone, as well as noting the body and head position during the EEG recording (supine versus prone) to avoid overinterpretation of respiratory, head movement, electrode, muscle or other artifacts. There is slight elevation of intracranial pressure in the prone position. In non-comatose patients, the hyperventilation procedure should be avoided. At present, non-specific EEG findings and abnormalities should not be considered as being specific for COVID-19 related encephalopathy.
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Affiliation(s)
- Philippe Gélisse
- Epilepsy Unit, Hôpital Gui de Chauliac, Montpellier, France; Research Unit (URCMA: Unité de Recherche sur les Comportements et Mouvements Anormaux), INSERM, U661, Montpellier F-34000, France.
| | - Andrea O Rossetti
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Pierre Genton
- Neurology Department, Hôpital Saint Charles, 13100 Aix en Provence, France
| | - Arielle Crespel
- Epilepsy Unit, Hôpital Gui de Chauliac, Montpellier, France; Research Unit (URCMA: Unité de Recherche sur les Comportements et Mouvements Anormaux), INSERM, U661, Montpellier F-34000, France
| | - Peter W Kaplan
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Specific EEG Encephalopathy Pattern in SARS-CoV-2 Patients. J Clin Med 2020; 9:jcm9051545. [PMID: 32443834 PMCID: PMC7291269 DOI: 10.3390/jcm9051545] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/13/2020] [Accepted: 05/18/2020] [Indexed: 12/14/2022] Open
Abstract
We used quantified electroencephalography (qEEG) to define the features of encephalopathy in patients released from the intensive care unit after severe illness from COVID-19. Artifact-free 120-300 s epoch lengths were visually identified and divided into 1 s windows with 10% overlap. Differential channels were grouped by frontal, parieto-occipital, and temporal lobes. For every channel and window, the power spectrum was calculated and used to compute the area for delta (0-4 Hz), theta (4-8 Hz), alpha (8-13 Hz), and beta (13-30 Hz) bands. Furthermore, Shannon's spectral entropy (SSE) and synchronization by Pearson's correlation coefficient () were computed; cases of patients diagnosed with either infectious toxic encephalopathy (ENC) or post-cardiorespiratory arrest (CRA) encephalopathy were used for comparison. Visual inspection of EEGs of COVID patients showed a near-physiological pattern with scarce anomalies. The distribution of EEG bands was different for the three groups, with COVID midway between distributions of ENC and CRA; specifically, temporal lobes showed different distribution for EEG bands in COVID patients. Besides, SSE was higher and hemispheric connectivity lower for COVID. We objectively identified some numerical EEG features in severely ill COVID patients that can allow positive diagnosis of this encephalopathy.
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Ricci L, Motolese F, Tombini M, Lanzone J, Rea R, Di Matteo F, Di Lazzaro V, Assenza G. Metronidazole Encephalopathy EEG Features: A Case Report with Systematic Review of the Literature. Brain Sci 2020; 10:E227. [PMID: 32290116 PMCID: PMC7226540 DOI: 10.3390/brainsci10040227] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/29/2020] [Accepted: 04/07/2020] [Indexed: 01/03/2023] Open
Abstract
Metronidazole-induced encephalopathy (MIE) is a rare and often under-recognized iatrogenic condition. The diagnosis should be considered in metronidazole-treated patients presenting with acute encephalopathy, unprovoked seizures and cerebellar signs. While typical magnetic resonance imaging (MRI) findings strongly support the diagnosis, electroencephalography (EEG) features have been rarely reported and poorly described. We present a longitudinal EEG assessment in one patient with encephalopathy due to metronidazole toxicity who presented a peculiar EEG pattern presentation and evolution. During the acute phase of encephalopathy, the EEG showed a monomorphic, sharply contoured theta activity symmetrically represented over frontal regions with an anterior-posterior progression which evolved in parallel with clinical worsening. Together with a systematic review of the literature, we discuss whether this EEG activity may represent a distinct neurophysiological correlate of 'cerebellar encephalopathy'.
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Affiliation(s)
- Lorenzo Ricci
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo 21, 00128 Rome, Italy; (M.T.); (J.L.); (V.D.L.); (G.A.)
| | - Francesco Motolese
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo 21, 00128 Rome, Italy; (M.T.); (J.L.); (V.D.L.); (G.A.)
| | - Mario Tombini
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo 21, 00128 Rome, Italy; (M.T.); (J.L.); (V.D.L.); (G.A.)
| | - Jacopo Lanzone
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo 21, 00128 Rome, Italy; (M.T.); (J.L.); (V.D.L.); (G.A.)
| | - Roberta Rea
- Digestive Endoscopy Unit, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo21, 00128 Rome, Italy; (R.R.); (F.D.M.)
| | - Francesco Di Matteo
- Digestive Endoscopy Unit, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo21, 00128 Rome, Italy; (R.R.); (F.D.M.)
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo 21, 00128 Rome, Italy; (M.T.); (J.L.); (V.D.L.); (G.A.)
| | - Giovanni Assenza
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo 21, 00128 Rome, Italy; (M.T.); (J.L.); (V.D.L.); (G.A.)
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Raucci U, Pro S, Di Capua M, Di Nardo G, Villa MP, Striano P, Parisi P. A reappraisal of the value of video-EEG recording in the emergency department. Expert Rev Neurother 2020; 20:459-475. [PMID: 32249626 DOI: 10.1080/14737175.2020.1747435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Stefano Pro
- Neurophysiological Unit, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Matteo Di Capua
- Neurophysiological Unit, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Giovanni Di Nardo
- Chair of Pediatrics, Child Neurology, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, c/o Sant’Andrea Hospital, Rome, Italy
| | - Maria Pia Villa
- Chair of Pediatrics, Child Neurology, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, c/o Sant’Andrea Hospital, Rome, Italy
| | - Pasquale Striano
- Paediatric Neurology and Muscular Diseases Unit, IRCCS ‘G. Gaslini’ Institute, Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, ‘G. Gaslini’ Institute, Genova, Italy
| | - Pasquale Parisi
- Chair of Pediatrics, Child Neurology, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, c/o Sant’Andrea Hospital, Rome, Italy
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Language impairment in adults with end-stage liver disease: application of natural language processing towards patient-generated health records. NPJ Digit Med 2019; 2:106. [PMID: 31701020 PMCID: PMC6828779 DOI: 10.1038/s41746-019-0179-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 09/23/2019] [Indexed: 12/17/2022] Open
Abstract
End-stage liver disease (ESLD) is associated with cognitive impairment ranging from subtle alterations in attention to overt hepatic encephalopathy that resolves after transplant. Natural language processing (NLP) may provide a useful method to assess cognitive status in this population. We identified 81 liver transplant recipients with ESLD (4/2013–2/2018) who sent at least one patient-to-provider electronic message pre-transplant and post-transplant, and matched them 1:1 to “healthy” controls—who had similar disease, but had not been evaluated for liver transplant—by age, gender, race/ethnicity, and liver disease. Messages written by patients pre-transplant and post-transplant and controls was compared across 19 NLP measures using paired Wilcoxon signed-rank tests. While there was no difference overall in word length, patients with Model for End-Stage Liver Disease Score (MELD) ≥ 30 (n = 31) had decreased word length in pre-transplant messages (3.95 [interquartile range (IQR) 3.79, 4.14]) compared to post-transplant (4.13 [3.96, 4.28], p = 0.01) and controls (4.2 [4.0, 4.4], p = 0.01); there was no difference between post-transplant and controls (p = 0.4). Patients with MELD ≥ 30 had fewer 6+ letter words in pre-transplant messages (19.5% [16.4, 25.9] compared to post-transplant (23.4% [20.0, 26.7] p = 0.02) and controls (25.0% [19.2, 29.4]; p = 0.01). Overall, patients had increased sentence length pre-transplant (12.0 [9.8, 13.7]) compared to post-transplant (11.0 [9.2, 13.3]; p = 0.046); the same was seen for MELD ≥ 30 (12.3 [9.8, 13.7] pre-transplant vs. 10.8 [9.6, 13.0] post-transplant; p = 0.050). Application of NLP to patient-generated messages identified language differences—longer sentences with shorter words—that resolved after transplant. NLP may provide opportunities to detect cognitive impairment in ESLD.
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Management of antibody-mediated autoimmune encephalitis in adults and children: literature review and consensus-based practical recommendations. Neurol Sci 2019; 40:2017-2030. [PMID: 31161339 DOI: 10.1007/s10072-019-03930-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 05/09/2019] [Indexed: 12/24/2022]
Abstract
Autoimmune encephalitis associated with antibodies against neuronal surface targets (NSAE) are rare but still underrecognized conditions that affect adult and pediatric patients. Clinical guidelines have recently been published with the aim of providing diagnostic clues regardless of antibody status. These syndromes are potentially treatable but the choice of treatment and its timing, as well as differential diagnoses, long-term management, and clinical and paraclinical follow-up, remain major challenges. In the absence of evidence-based guidelines, management of these conditions is commonly based on single-center expertise.Taking into account different published expert recommendations in addition to the multicenter experience of the Italian Working Group on Autoimmune Encephalitis, both widely accepted and critical aspects of diagnosis, management and particularly of immunotherapy for NSAE have been reviewed and are discussed.Finally, we provide consensus-based practical advice for managing hospitalization and follow-up of patients with NSAE.
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Electroencephalographic monitoring in the critically ill patient: What useful information can it contribute? Med Intensiva 2019; 44:301-309. [PMID: 31164247 DOI: 10.1016/j.medin.2019.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 02/03/2023]
Abstract
Monitoring is a crucial part of the care of the critically ill patient. It detects organ dysfunction and provides guidance on the therapeutic approach. Intensivists closely monitor the function of various organ systems, and the brain is no exception. Continuous EEG monitoring is a noninvasive and uninterrupted way of assessing cerebral cortical activity with good spatial and excellent temporal resolution. The diagnostic effectiveness of non-convulsive status epilepticus as a cause of unexplained consciousness disorder has increased the use of continuous EEG monitoring in the neurocritical care setting. However, non-convulsive status epilepticus is not the only indication for the assessment of cerebral cortical activity. This study summarizes the indications, usage and methodology of continuous EEG monitoring in the intensive care unit, with the aim of allowing practitioners to become familiarized the technique.
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39
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Clinical neurophysiology of altered states of consciousness: Encephalopathy and coma. HANDBOOK OF CLINICAL NEUROLOGY 2019; 161:73-88. [PMID: 31307621 DOI: 10.1016/b978-0-444-64142-7.00041-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The neurophysiologist will commonly encounter patients with encephalopathy/delirium (altered consciousness with impaired cognition, usually with sleep-wake cycle alteration and lethargy) or coma (an eyes-closed state of unresponsiveness) in the hospital setting. Assessing the background frequency of the EEG, as well as the presence or absence of other features (reactivity, periodic discharges such as triphasic waves), can provide insight into the patient's underlying condition and in some cases may provide prognostic information. The literature of postanoxic arrest EEG patterns continues to expand. Other neurophysiologic tests, such as somatosensory evoked potentials, auditory mismatch negativity, and even EMG, may also play a role in assessing brain function; distinguishing among a locked-in state, minimally conscious state, persistent vegetative state, and waking/unresponsive states; and assessing the potential for recovery after brain injury.
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40
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Palanca BJA, Wildes TS, Ju YS, Ching S, Avidan MS. Electroencephalography and delirium in the postoperative period. Br J Anaesth 2018; 119:294-307. [PMID: 28854540 DOI: 10.1093/bja/aew475] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Delirium commonly manifests in the postoperative period as a clinical syndrome resulting from acute brain dysfunction or encephalopathy. Delirium is characterized by acute and often fluctuating changes in attention and cognition. Emergence delirium typically presents and resolves within minutes to hours after termination of general anaesthesia. Postoperative delirium hours to days after an invasive procedure can herald poor outcomes. Easily recognized when patients are hyperactive or agitated, delirium often evades diagnosis as it most frequently presents with hypoactivity and somnolence. EEG offers objective measurements to complement clinical assessment of this complex fluctuating disorder. Although EEG features of delirium in the postoperative period remain incompletely characterized, a shift of EEG power into low frequencies is a typical finding shared among encephalopathies that manifest with delirium. In aggregate, existing data suggest that serial or continuous EEG in the postoperative period facilitates monitoring of delirium development and severity and assists in detecting epileptic aetiologies. Future studies are needed to clarify the precise EEG features that can reliably predict or diagnose delirium in the postoperative period, and to provide mechanistic insights into this pathologically diverse neurological disorder.
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Affiliation(s)
| | | | | | - S Ching
- Department of Electrical and Systems Engineering.,Department of Biomedical Engineering
| | - M S Avidan
- Department of Anesthesiology.,Department of Surgery, Division of Cardiothoracic Surgery, Washington University School of Medicine in St Louis, St Louis, MO, USA
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41
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Bentes C, Peralta AR, Viana P, Martins H, Morgado C, Casimiro C, Franco AC, Fonseca AC, Geraldes R, Canhão P, Pinho e Melo T, Paiva T, Ferro JM. Quantitative EEG and functional outcome following acute ischemic stroke. Clin Neurophysiol 2018; 129:1680-1687. [DOI: 10.1016/j.clinph.2018.05.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 03/27/2018] [Accepted: 05/08/2018] [Indexed: 10/14/2022]
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Fanciullacci C, Bertolucci F, Lamola G, Panarese A, Artoni F, Micera S, Rossi B, Chisari C. Delta Power Is Higher and More Symmetrical in Ischemic Stroke Patients with Cortical Involvement. Front Hum Neurosci 2017; 11:385. [PMID: 28804453 PMCID: PMC5532374 DOI: 10.3389/fnhum.2017.00385] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 07/10/2017] [Indexed: 01/21/2023] Open
Abstract
A brain injury resulting from unilateral stroke critically alters brain functionality and the complex balance within the cortical activity. Such modifications may critically depend on lesion location and cortical involvement. Indeed, recent findings pointed out the necessity of applying a stratification based on lesion location when investigating inter-hemispheric balance in stroke. Here, we tested whether cortical involvement could imply differences in band-specific activity and brain symmetry in post stroke patients with cortico-subcortical and subcortical strokes. We explored brain activity related to lesion location through EEG power analysis and quantitative Electroencephalography (qEEG) measures. Thirty stroke patients in the subacute phase and 10 neurologically intact age-matched right-handed subjects were enrolled. Stroke patients were equally subdivided in two groups based on lesion location: cortico-subcortical (CS, mean age ± SD: 72.21 ± 10.97 years; time since stroke ± SD: 31.14 ± 11.73 days) and subcortical (S, mean age ± SD: 68.92 ± 10.001 years; time since stroke ± SD: 26.93 ± 13.08 days) group. We assessed patients’ neurological status by means of National Institutes of Health Stroke Scale (NIHSS). High density EEG at rest was recorded and power spectral analysis in Delta (1–4 Hz) and Alpha (8–14 Hz) bands was performed. qEEG metrics as pairwise derived Brain Symmetry Index (pdBSI) and Delta/Alpha Ratio (DAR) were computed and correlated with NIHSS score. S showed a lower Delta power in the Unaffected Hemisphere (UH) compared to Affected Hemisphere (AH; z = −1.98, p < 0.05) and a higher Alpha power compared to CS (z = −2.18, p < 0.05). pdBSI was negatively correlated with NIHSS (R = −0.59, p < 0.05). CS showed a higher value and symmetrical distribution of Delta band activity (z = −2.37, p < 0.05), confirmed also by a higher DAR value compared to S (z = −2.48, p < 0.05). Patients with cortico-subcortical and subcortical lesions show different brain symmetry in the subacute phase. Interestingly, in subcortical stroke patient brain activity is related with the clinical function. qEEG measures can be explicative of brain activity related to lesion location and they could allow precise definition of diagnostic-therapeutic algorithms in stroke patients.
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Affiliation(s)
- Chiara Fanciullacci
- Neurorehabilitation Unit, University Hospital of PisaUniversity of Pisa, Pisa, Italy.,The BioRobotic Institute, Scuola Superiore Sant'AnnaPisa, Italy
| | - Federica Bertolucci
- Neurorehabilitation Unit, University Hospital of PisaUniversity of Pisa, Pisa, Italy
| | - Giuseppe Lamola
- Neurorehabilitation Unit, University Hospital of PisaUniversity of Pisa, Pisa, Italy
| | | | - Fiorenzo Artoni
- The BioRobotic Institute, Scuola Superiore Sant'AnnaPisa, Italy
| | - Silvestro Micera
- The BioRobotic Institute, Scuola Superiore Sant'AnnaPisa, Italy.,Translational Neuroengineering Lab, School of Engineering, École Polytechnique Fèdèrale de LausanneLausanne, Switzerland
| | - Bruno Rossi
- Neurorehabilitation Unit, University Hospital of PisaUniversity of Pisa, Pisa, Italy
| | - Carmelo Chisari
- Neurorehabilitation Unit, University Hospital of PisaUniversity of Pisa, Pisa, Italy
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43
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Haggstrom L, Welschinger R, Caplan GA. Functional neuroimaging offers insights into delirium pathophysiology: A systematic review. Australas J Ageing 2017; 36:186-192. [DOI: 10.1111/ajag.12417] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Lucy Haggstrom
- University of New South Wales; Sydney New South Wales Australia
| | - Robert Welschinger
- Department of Geriatric Medicine; Prince of Wales Hospital; Sydney New South Wales Australia
| | - Gideon A Caplan
- Department of Geriatric Medicine; Prince of Wales Hospital; Sydney New South Wales Australia
- Prince of Wales Clinical School; University of New South Wales; Sydney New South Wales Australia
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Abstract
Hepatic encephalopathy (HE) is a reversible syndrome of impaired brain function occurring in patients with advanced liver diseases. The precise pathophysiology of HE is still under discussion; the leading hypothesis focus on the role of neurotoxins, impaired neurotransmission due to metabolic changes in liver failure, changes in brain energy metabolism, systemic inflammatory response and alterations of the blood brain barrier. HE produces a wide spectrum of nonspecific neurological and psychiatric manifestations. Minimal HE is diagnosed by abnormal psychometric tests. Clinically overt HE includes personality changes, alterations in consciousness progressive disorientation in time and space, somnolence, stupor and, finally, coma. Except for clinical studies, no specific tests are required for diagnosis. HE is classified according to the underlying disease, the severity of manifestations, its time course and the existence of precipitating factors. Treatment of overt HE includes supportive therapies, treatment of precipitating factors, lactulose and/or rifaximin. Routine treatment for minimal HE is only recommended for selected patients.
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Affiliation(s)
- Peter Ferenci
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
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45
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Wrzosek M, Ives JR, Karczewski M, Dziadkowiak E, Gruszka E. The relationship between epileptiform discharges and background activity in the visual analysis of electroencephalographic examinations in dogs with seizures of different etiologies. Vet J 2017; 222:41-51. [PMID: 28410675 DOI: 10.1016/j.tvjl.2017.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 03/12/2017] [Accepted: 03/13/2017] [Indexed: 01/30/2023]
Abstract
Electroencephalographic (EEG) recordings in 125 outpatient dogs with various epileptiform encephalopathies were acquired under medetomidine sedation using subdermal wire electrodes. The features of canine EEG (background activity [BGA] and epileptiform discharges [EDs]) were assessed, described and compared. The dogs included neurologically healthy controls (N, n = 19), dogs with portosystemic shunt (PSS, n = 9), dogs with intracranial pathologies (IP, n = 27) and dogs with idiopathic epilepsy (IE, n = 70). A visual EEG analysis revealed significantly more pronounced high voltage, low-frequency BGA in the PSS and IP groups in comparison to the N and IE groups (PSS vs. N, PSS vs. IE P <0.0001; IP vs. N, IP vs. IE P = 0.043). At least one ED in the recording was found in 47.37% (n = 9/19) of the individuals in the N group, 88.9% (n = 8/9) of the dogs in the PSS group, 77.78% (n = 21/27) of the dogs in the IP group and 61.43% (n = 43/70) of the dogs in the IE group. The presence of bilateral symmetric triphasic (BST) waves was significantly higher in the PSS group than in the remaining groups. There was a strong prevalence of spike-waves in dogs with idiopathic epilepsy and of BST waves in dogs with portosystemic shunt. None of the dogs in group N had spike-waves or BST activity. EDs were observed more frequently in high and very high voltage, low frequency BGA than in low voltage, high frequency BGA.
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Affiliation(s)
- M Wrzosek
- Department of Internal Medicine and Clinic for Horses, Dogs and Cats, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, pl. Grunwaldzki 47, 50-366 Wrocław, Poland.
| | - J R Ives
- Department of Neuroscience, University of Western Ontario, London, Ontario, Canada
| | - M Karczewski
- Department of Mathematics, Faculty of Environmental Engineering and Geodesy, Wroclaw University of Environmental and Life Sciences, ul. Grunwaldzka 55, 50-357 Wrocław, Poland
| | - E Dziadkowiak
- Department of Neurology, Wrocław Medical University, ul. Borowska 213, 50-556 Wrocław, Poland
| | - E Gruszka
- Department of Neurology, Wrocław Medical University, ul. Borowska 213, 50-556 Wrocław, Poland
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Kober SE, Schweiger D, Reichert JL, Neuper C, Wood G. Upper Alpha Based Neurofeedback Training in Chronic Stroke: Brain Plasticity Processes and Cognitive Effects. Appl Psychophysiol Biofeedback 2017; 42:69-83. [PMID: 28197747 PMCID: PMC5344963 DOI: 10.1007/s10484-017-9353-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
In the present study, we investigated the effects of upper alpha based neurofeedback (NF) training on electrical brain activity and cognitive functions in stroke survivors. Therefore, two single chronic stroke patients with memory deficits (subject A with a bilateral subarachnoid hemorrhage; subject B with an ischemic stroke in the left arteria cerebri media) and a healthy elderly control group (N = 24) received up to ten NF training sessions. To evaluate NF training effects, all participants performed multichannel electroencephalogram (EEG) resting measurements and a neuropsychological test battery assessing different cognitive functions before and after NF training. Stroke patients showed improvements in memory functions after successful NF training compared to the pre-assessment. Subject B had a pathological delta (0.5-4 Hz) and upper alpha (10-12 Hz) power maximum over the unaffected hemisphere before NF training. After NF training, he showed a more bilateral and "normalized" topographical distribution of these EEG frequencies. Healthy participants as well as subject A did not show any abnormalities in EEG topography before the start of NF training. Consequently, no changes in the topographical distribution of EEG activity were observed in these participants when comparing the pre- and post-assessment. Hence, our results show that upper alpha based NF training had on the one hand positive effects on memory functions, and on the other hand led to cortical "normalization" in a stroke patient with pathological brain activation patterns, which underlines the potential usefulness of NF as neurological rehabilitation tool.
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Affiliation(s)
- Silvia Erika Kober
- Department of Psychology, University of Graz, Universitaetsplatz 2/III, 8010 Graz, Austria
- BioTechMed-Graz, Mozartgasse 12/II, Graz, 8010 Austria
| | - Daniela Schweiger
- Department of Psychology, University of Graz, Universitaetsplatz 2/III, 8010 Graz, Austria
| | | | - Christa Neuper
- Department of Psychology, University of Graz, Universitaetsplatz 2/III, 8010 Graz, Austria
- BioTechMed-Graz, Mozartgasse 12/II, Graz, 8010 Austria
- Institute of Neural Engineering, Laboratory of Brain-Computer Interfaces, Graz University of Technology, Stremayrgasse 16, Graz, 8010 Austria
| | - Guilherme Wood
- Department of Psychology, University of Graz, Universitaetsplatz 2/III, 8010 Graz, Austria
- BioTechMed-Graz, Mozartgasse 12/II, Graz, 8010 Austria
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47
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Abstract
Delirium is common in critically ill patients and associated with increased length of stay in the intensive care unit (ICU) and long-term cognitive impairment. The pathophysiology of delirium has been explained by neuroinflammation, an aberrant stress response, neurotransmitter imbalances, and neuronal network alterations. Delirium develops mostly in vulnerable patients (e.g., elderly and cognitively impaired) in the throes of a critical illness. Delirium is by definition due to an underlying condition and can be identified at ICU admission using prediction models. Treatment of delirium can be improved with frequent monitoring, as early detection and subsequent treatment of the underlying condition can improve outcome. Cautious use or avoidance of benzodiazepines may reduce the likelihood of developing delirium. Nonpharmacologic strategies with early mobilization, reducing causes for sleep deprivation, and reorientation measures may be effective in the prevention of delirium. Antipsychotics are effective in treating hallucinations and agitation, but do not reduce the duration of delirium. Combined pain, agitation, and delirium protocols seem to improve the outcome of critically ill patients and may reduce delirium incidence.
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Affiliation(s)
- A J C Slooter
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - R R Van De Leur
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - I J Zaal
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
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48
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Toda Y, Yamazaki M, Ota T, Fujisawa Y, Kimura K. A case of Cefepime encephalopathy, being difficult to distinguish from non-convulsive status epilepticus during the treatment of bacterial meningitis. Rinsho Shinkeigaku 2016; 56:678-683. [PMID: 27680224 DOI: 10.5692/clinicalneurol.cn-000898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 64-year-old man with fever, appetite loss, and pain in the back of the neck visited our hospital. We diagnosed him as having bacterial meningitis because of pleocytosis of the cerebrospinal fluid, and started treatment with antibiotics. Multiple cerebral infarcts were found on brain MRI. We suspected that the origin of the bacterial meningitis was infective endocarditis, and administered Cefepime and Gentamicin according to the guidelines for treatment of infective endocarditis. Three days later, he became drowsy and had myoclonus and flapping of the extremities. An electroencephalograph showed generalized periodic discharge and a triphasic wave pattern. We thought that the cause of disturbance in consciousness was Cefepime-induced encephalopathy, and stopped administration of Cefepime. A few days later, he became clear, and the myoclonus and flapping disappeared. It was difficult to distinguish between non-convulsive status epilepticus and Cefepime-induced encephalopathy. However, since stopping Cefepime treatment had made the patient clear, we diagnosed his condition as Cefepime-induced encephalopathy, which often occurs in patients with renal or liver dysfunction, or in brain infarction or meningitis, which results in blood-brain barrier disruption. Thus, care should be taken when administering Cefepime to such patients.
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Affiliation(s)
- Yusuke Toda
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School
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49
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EEG for Diagnosis and Prognosis of Acute Nonhypoxic Encephalopathy: History and Current Evidence. J Clin Neurophysiol 2016; 32:456-64. [PMID: 26629755 DOI: 10.1097/wnp.0000000000000164] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The term encephalopathy encompasses a wide variety of complex syndromes caused by a large number of different toxic, metabolic, infectious, and degenerative derangements. Acute encephalopathy typically presents with a fluctuating course involving alteration of mental status or confusion and decreased (or rarely increased) motor activity. There usually are lethargy, cognitive impairment, altered memory and mental processing of information, and disturbed sleep-wake cycles. Encephalopathy mainly occurs in the elderly and is frequently encountered in intensive care units and postoperatively. Despite new diagnostic procedures and advances in intensive medical care, acute encephalopathy constitutes a significant cause of morbidity and mortality in hospitalized patients. EEG enables rapid bedside electrophysiological monitoring providing dynamic real-time information on neocortical brain activity and dysfunction. Hence, EEG complements clinical and neuroimaging assessments of encephalopathic patients. Progressive slowing of EEG background activity with increasing cerebral compromise, the emergence of episodic electrographic transients, seizures, and decreased EEG reactivity to external stimuli provide important diagnostic and prognostic information. The aim of this review was to provide a comprehensive overview of the current evidence for the diagnostic and prognostic value of EEG in adult intensive care unit patients with acute nonhypoxic encephalopathy.
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50
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Wabulya A, Lesser RP, Llinas R, Kaplan PW. Electroencephalography and Brain MRI Patterns in Encephalopathy. Clin EEG Neurosci 2016; 47:150-6. [PMID: 26062911 DOI: 10.1177/1550059415590058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 05/13/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Using electroencephalography (EEG) and histology in patients with diffuse encephalopathy, Gloor et al reported that paroxysmal synchronous discharges (PSDs) on EEG required combined cortical gray (CG) and "subcortical" gray (SCG) matter pathology, while polymorphic delta activity (PDA) occurred in patients with white matter pathology. In patients with encephalopathy, we compared EEG findings and magnetic resonance imaging (MRI) to determine if MRI reflected similar pathological EEG correlations. METHODS Retrospective case control study of 52 cases with EEG evidence of encephalopathy and 50 controls without evidence of encephalopathy. Review of clinical, EEG and MRI data acquired within 4 days of each other. RESULTS The most common EEG finding in encephalopathy was background slowing, in 96.1%. We found PSDs in 0% of cases with the combination of CG and SCG abnormalities. Although 13.5% (n=7) had PSDs on EEG; 3 of these had CG and 4 had SCG abnormalities. A total of 73.1% (38/52) had white matter abnormalities-of these 28.9% (11/38) had PDA. CONCLUSION PSDs were found with either CG or "SCG" MRI abnormalities and did not require a combination of the two. In agreement with Gloor et al, PDA occurred with white matter MRI abnormalities in the absence of gray matter abnormalities.
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Affiliation(s)
- Angela Wabulya
- Department of Neurology, University of North Carolina Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Ronald P Lesser
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rafael Llinas
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter W Kaplan
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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