Document Detail


Continuous EEG-SEP monitoring in severe brain injury.
MedLine Citation:
PMID:  19467438     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: To monitor acute brain injury in the neurological intensive care unit (NICU), we used EEG and somatosensory evoked potentials (SEP) in combination to achieve more accuracy in detecting brain function deterioration. METHODS: Sixty-eight patients (head trauma and intracranial hemorrhage; GCS<9) were monitored with continuous EEG-SEP and intracranial pressure monitoring (ICP). RESULTS: Fifty-five patients were considered "stable" or improving, considering the GCS and CT scan: in this group, SEP didn't show significant changes. Thirteen patients showed neurological deteriorations and, in all patients, cortical SEP showed significant alterations (amplitude decrease>50% often till complete disappearance). SEP deterioration anticipated ICP increase in 30%, was contemporary in 38%, and followed ICP increase in 23%. Considering SEP and ICP in relation to clinical course, all patients but one with ICP less than 20 mmHg were stable, while the three patients with ICP greater than 40 mmHg all died. Among the 26 patients with ICP of 20-40 mmHg, 17 were stable, while nine showed clinical and neurophysiological deterioration. Thus, there is a range of ICP values (20-40 mmHg) were ICP is scarcely indicative of clinical deterioration, rather it is the SEP changes that identify brain function deterioration. Therefore, SEP have a twofold interest with respect to ICP: their changes can precede an ICP increase and they can constitute a complementary tool to interpret ICP trends. It has been very important to associate SEP and EEG: about 60% of our patients were deeply sedated and, because of their relative insensitivity to anesthetics, only SEP allowed us to monitor brain damage evolution when EEG was scarcely valuable. CONCLUSIONS: We observed 3% of nonconvulsive status epilepticus compared to 18% of neurological deterioration. If the aim of neurophysiological monitoring is to "detect and protect", it may not be limited to detecting seizures, rather it should be able to identify brain deterioration, so we propose the combined monitoring of EEG with SEP.
Authors:
A Amantini; S Fossi; A Grippo; P Innocenti; A Amadori; L Bucciardini; C Cossu; C Nardini; S Scarpelli; V Roma; F Pinto
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Publication Detail:
Type:  Journal Article     Date:  2009-02-14
Journal Detail:
Title:  Neurophysiologie clinique = Clinical neurophysiology     Volume:  39     ISSN:  1769-7131     ISO Abbreviation:  Neurophysiol Clin     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-05-26     Completed Date:  2009-08-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8804532     Medline TA:  Neurophysiol Clin     Country:  France    
Other Details:
Languages:  eng     Pagination:  85-93     Citation Subset:  IM    
Affiliation:
Unit of Clinical Neurophysiology, DAI Neurological Sciences, University of Florence - Az., Ospedaliero Universitaria Careggi, V. le Morgagni 85, 50134 Florence, Italy. amantini@unifi.it
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Brain Injuries / etiology,  physiopathology*
Brain Ischemia / complications,  physiopathology
Disease Progression
Electroencephalography / methods*
Evoked Potentials, Somatosensory*
Female
Glasgow Coma Scale
Humans
Intracranial Hemorrhage, Traumatic / physiopathology
Intracranial Hypertension / diagnosis,  etiology,  mortality,  physiopathology
Male
Middle Aged
Monitoring, Physiologic / methods*
Status Epilepticus / physiopathology
Subarachnoid Hemorrhage / etiology,  physiopathology
Young Adult

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