Long-term Electroencephalography Monitoring Research Articles

Кластеризация эпилептиформных разрядов в индивидуальной диагностике ранней стадии отсроченной церебральной ишемии

To detect the onset of delayed cerebral ischemia after aneurysmal hemorrhage in the subarachnoid space, a clinical data method for detecting clusters of epileptiform discharges in the data of long-term electroencephalographic monitoring of patients was proposed and tested. It is based on the identification of distributions of epileptiform discharges that are continuous in time and exceed the adaptive threshold and have a clearly expressed interhemispheric asymmetry.

Risk Factors for Pressure Ulcer by Electrodes in Long-term Electroencephalography Monitoring

Background: Although electroencephalography is known as non-invasive, long-term electroencephalography monitoring has a significant risk of pressure ulcers caused by electrodes. We investigated the incidence and risk factors of pressure ulcers in long-term electroencephalography monitoring for more than 24 hours.Methods: All patients who underwent long-term electroencephalography monitoring for more than 24 hours from January 2020 to December 2021 were reviewed. Their medical records were reviewed to evaluate the risk factors for pressure ulcers by electroencephalography electrodes. All patients were divided into the presence (lesion positive) and absence (lesion negative) of pressure ulcers confirmed by a clinician.Results: A total of 541 patients were analyzed in this study. Their mean age was 56.0±21.5, and the average duration of the long-term electroencephalography monitoring was 118.0±68.6 hours. Pressure ulcers were identified in 49 patients (9.1%). The odds ratios of age and recording time were 1.032 (95% confidence interval [CI], 1.008-1.056, <i>p</i>=0.009) and 1.022 (95% CI, 1.015-1.029, <i>p</i><0.001), respectively. The odds ratio of pressure ulcer was 2.702 (95% CI, 1.461-4.999, <i>p</i>=0.002) in patients with comatose mentality (1 point for eye response of Glasgow coma scale).Conclusions: The pressure ulcers caused by electrodes in long-term electroencephalography monitoring can be preventable with due diligence in clinical settings. Risk factor control to prevent pressure ulcers due to electroencephalography electrodes is needed.

Pediatric Epilepsy Surgery: Indications and Evaluation.

Epilepsy is a common neurological condition in children. It is usually amenable to drug therapy. However, nearly one-third of patients may be refractory to antiseizure drugs. Poor compliance and nonepileptic events should be ruled out as possible causes of drug-resistant epilepsy (DRE). After failing adequate trials of two appropriate antiseizure drugs, patients with focal DRE or poorly classifiable epilepsy or epileptic encephalopathy with focal electro-clinical features should be worked up for surgical candidacy. A randomized controlled trial provided a class I evidence for epilepsy surgery in pediatric DRE. Pre-surgical screening workup typically includes a high-resolution epilepsy protocol brain magnetic resonance imaging (MRI) and a high-quality in-patient video electroencephalography evaluation. Advanced investigations such as positron emission tomography (PET), single-photon emission computed tomography (SPECT), and magnetoencephalography (MEG) may be required in selected cases especially when brain MRI is normal, and further evidence for anatomo-electro-clinical concordance is necessary to refine candidacy for surgery and surgical strategy. Some children may also need functional MRI to map eloquent regions of interest such as motor, sensory, and language functions to avoid unacceptable neurological deficits after surgery. Selected children may need invasive long-term electroencephalographic monitoring using stereotactically implanted intracranial depth electrodes or subdural grids. Surgical options include resective surgeries (lesionectomy, lobectomy, multilobar resections) and disconnective surgeries (corpus callosotomy, etc.) with the potential to obtain seizure freedom. Other surgical procedures, typically considered to be palliative are neuromodulation [deep brain stimulation (DBS), vagal nerve stimulation (VNS), and responsive neural stimulation (RNS)]. DBS and RNS are currently not approved in children. Pediatric DRE should be evaluated early considering the risk of epileptic encephalopathy and negative impact on cognition.

Presence of generalized periodic discharges and hospital mortality.

Generalized periodic discharges (GPDs) are rare patterns that can be found in long-term electroencephalographic monitoring in critical patients. These patterns have been correlated with non-seizure crisis and non-convulsive status epilepticus, associated with poor prognosis. To compare the outcome between patients who developed GPDs and patients with other abnormalities in long-term electroencephalographic monitoring. A retrospective study was performed by analyzing the medical records of 112 patients over 18 years who developed GPDs during long-term electroencephalographic monitoring (12‒16 hours of monitoring) in the intensive care unit of a general hospital, compared with a group that had only nonspecific abnormalities in the monitoring. Age and cardiorespiratory arrest (CA) were risk factors for death - OR 1.04 (95% CI 1,02 - 1,07) and p<0.001; OR 3.00 (95% CI 1,01 - 8,92) and p=0.046, respectively. It was not possible to evaluate if GPDs alone were associated with an unfavorable outcome or would be a bias for the development of CA in these patients. However, of the six isolated GPDs cases, 2/3 evolved to death, showing a tendency to worse prognosis. A significant difference (p=0.031) was observed for a worse outcome when comparing the group of 28 patients who presented GPD or CA with the other group which did not present any of these variables; of these 28 patients, 20 (71.4%) died. The presence of post-CA GPDs was associated with worse prognosis, but it was not clear whether these patterns are independent factors of an unfavorable evolution.

Status epilepticus: Analysis of refractory cases

Objective: to analyze refractory status epilepticus (SE) cases. Patients and methods. Fifteen female patients aged 21 to 62 years with refractory SE were comprehensively examined using long-term electroencephalography monitoring. The investigators evaluated the efficiency of treatment regimens with intravenous antiepileptic drugs (AEDs), such as diazepam (DZP); valproic acid (VPA); levetiracetam; and lacosamide and their combinations, at the prehospital and hospital stages, as well as SE therapy complications noted only in the intravenous administration of narcotics (propofol, sodium thiopental). Results and discussion. A fetal outcome due to multiple organ dysfunction indirectly related to SE was recorded in 2 (13.3%) patients with acute symptomatic status. SE was abolished in the other 13 cases. The preliminary findings may suggest that it is appropriate to prescribe VPA just at the prehospital stage. The co-administration of VPA and DZP substantially enhances the efficiency of SE therapy. The maximum acceptable doses of AEDs using the whole available therapeutic arsenal should be administered within the first hours of acute symptomatic SE.

Clinical evolution of seizures: distribution across time of day and sleep/wakefulness cycle

Seizures can evolve sequentially into different clinical phases. For example, a seizure may start as an aura (first phase), then evolve into a tonic seizure (second phase), and evolve further into a generalized tonic-clonic semiology (third phase). It is currently unknown whether specific seizure evolutions cluster at particular times of the day and/or during sleep/wakefulness. We aimed to describe the distribution of the clinical evolution of seizures across time of day and sleep/wake state. We included all patients with at least two seizure phases admitted for long-term electroencephalogram monitoring during a 5 year period. Two-hundred-and-fifteen patients (866 seizures) presented with two different phases and 87 patients (324 seizures) evolved into a third clinical phase. During phase two, evolution into clonic seizures differed across time (p = 0.047) with peaks at 0-3 h and 6-9 h and during sleep (p < 0.001), evolution into automotor seizures peaked during wakefulness (p = 0.015), evolution into tonic seizures differed across time (p = 0.005) with peaks at 21-12 h and during sleep (p = 0.0119), and generalized tonic-clonic seizures peaked during sleep (p = 0.0067). Findings remained statistically significant after multivariable analysis adjusting, separately, for potential confounders (semiology of the first phase, age, gender, days in the long-term electroencephalographic monitoring unit, abnormal neuroimaging, number of antiepileptic medications, and seizure localization). During phase three, seizure evolutions followed the same pattern of distribution as during phase two but differences did not reach statistical significance. Our data demonstrate that the evolution of seizures into different phases cluster at specific times of day and at specific phases of the sleep/wakefulness cycle.

Long-Term EEG Monitoring: A Clinical Approach to Electrophysiology

ABSTRACT.Long-term electroencephalographic monitoring (LTM) is the capability of recording the EEG over long periods of time and not a specific duration. Prolonged EEG recording is used primarily for epilepsy monitoring, but LTM is also used in the intensive care unit, the operating room, and the emergency department. The purpose of LTM is to expand the limited time sampling associated with shorter “routine” EEG recording. Audiovisual monitoring may also be used in conjunction with LTM to evaluate simultaneously a specific clinical behavior that may or may not be associated with EEG alteration. This is typically performed in a hospital setting for safety and ancillary testing purposes. LTM is used most frequently in the diagnosis and management of seizures and “spells,” but has also gained wider application in the evaluation of sleep disorders, cerebrovascular disease, psychiatric conditions, and movement disorders. Computer-assisted LTM systems that process, analyze, compress and store data digitally have become widely available in clinical practice both in the hospital as well as outside the hospital when the patient is ambulatory.

Long-term EEG monitoring: a clinical approach to electrophysiology.

Long-term electroencephalographic monitoring (LTM) is the capability of recording the EEG over long periods of time and not a specific duration. Prolonged EEG recording is used primarily for epilepsy monitoring, but LTM is also used in the intensive care unit, the operating room, and in the emergency department. The purpose of LTM is to expand the limited time sampling associated with shorter "routine" EEG recording. Audiovisual monitoring may also be used in conjunction with LTM to evaluate simultaneously a specific clinical behavior that may or may not be associated with EEG alteration. This is typically performed in a hospital setting for safety and ancillary testing purposes. LTM is used most frequently in the diagnosis and management of seizures and "spells," but has also gained wider application in the evaluation of sleep disorders, cerebrovascular disease, psychiatric conditions, and movement disorders. Computer-assisted LTM systems that process, analyze, compress, and store data digitally have become widely available in clinical practice both in the hospital as well as outside the hospital when the patient is ambulatory.

Long-term electroencephalographic monitoring for diagnosis and management of seizures.

Long-term electroencephalographic (EEG) monitoring is the process of recording an EEG for a prolonged period in order to document epileptic seizures or other episodic disturbances of neurologic function. Indications for long-term EEG monitoring include diagnosis of a seizure disorder (epilepsy), classification of seizure types in patients with epilepsy, and localization of the epileptogenic region of the brain. Methods used for long-term EEG monitoring include prolonged analog or digital EEG, prolonged analog or digital ambulatory EEG, and prolonged analog or digital video-EEG monitoring with telemetry. Each of these methods has distinct advantages and disadvantages, particularly relative to storage, retrieval, and manipulation of data. Long-term EEG monitoring is useful in the management of patients with epilepsy and in the diagnosis of a seizure disorder. For most patients, inpatient long-term EEG monitoring is best performed in a specialized epilepsy-monitoring unit, which can provide a safe environment and both educational and psychosocial support. The choice of the most appropriate method of long-term monitoring for a specific clinical situation is best made by an epileptologist or a neurologist at an epilepsy center.

Long-Term Electroencephalographic Monitoring for Diagnosis and Management of Seizures

Long-Term Electroencephalographic Monitoring for Diagnosis and Management of Seizures

Temporal lobectomy for complex partial seizures that began in childhood

Forty-six consecutive patients who underwent surgery for intractable temporal lobe seizures originating in childhood are reported; invasive preoperative monitoring (e.g., depth electrodes and subdural arrays) was not used in the selection process. Our results, with respect to the control of seizures and improvement in behavior, are comparable to those of series in which invasive monitoring was used in the selection process. Eighty-five percent of the 46 patients (96% of the 28 operated after the introduction of longterm electroencephalographic monitoring) became either seizure free or experienced near total control of their seizures. Our results indicate that many patients can be selected successfully for temporal resection without exposure to the risk and expense of invasive presurgical procedures. A long duration of epilepsy prior to surgery in patients with neoplasia portended a less satisfactory outcome. Our results strengthen the argument for early operation in children with intractable epilepsy.

Results of Surgery for Extratemporal Partial Epilepsy That Began in Childhood

Thirty-five consecutive patients who underwent surgery for intractable extratemporal seizures originating in childhood are described. Candidates for surgery were selected on the basis of clinical criteria, neurodiagnostic imaging, and an electroencephalographic investigation that included the use of sphenoidal electrodes and long-term monitoring. Invasive preoperative monitoring was not used. Our results, with respect to the control of seizures and behavioral improvement, are comparable with series in which data from invasive recordings were used in the selection process. Sixty-three percent of the 35 patients (76.5% of those operated on after the introduction of long-term electroencephalographic monitoring) became either seizure free or experienced a reduction in their frequency of seizures by at least 75%. The favorable outcome in this group of patients strengthens the argument for early operation in children with intractable epilepsy, even when the seizure focus is outside the temporal lobe.

Classification of Epileptic Seizures and the Epilepsies

Recent activity in the classification of epileptic seizures and in the classification of the epilepsies has been based on the ability to identify accurately (1) individual seizure types, (2) the progression of one type of seizure into another during the course of a single seizure, and (3) the repertoire of different seizures and other symptoms allowing the identification of epileptic syndromes. Much of this activity has resulted from the technologic advances in video recording, long-term electroencephalographic monitoring, and the incorporation of both into the clinical armamentarium.