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EEG Characteristics Before and After Dexmedetomidine Treatment in Severe Patients: A Prospective Study. 重症患者右美托咪定治疗前后的脑电图特征:一项前瞻性研究
IF 2 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-05-01 Epub Date: 2022-12-20 DOI: 10.1177/15500594221144570
Yujie Ma, Hongbin Zhang, Jijia Bai, Jinyuan Zhu

Background. Bedside electroencephalography (EEG) can monitor the changes in brain function in critical patients. Light sedation is recommended in intensive care unit (ICU) patients, but sedation might confuse the EEG readings. There are few studies on the changes of EEG in severe patients with dexmedetomidine. This study aimed to explore the EEG characteristics before and after dexmedetomidine in severe patients in the ICU. Methods. This prospective study enrolled severe patients with sepsis who needed light sedation, we sedated the patients with dexmedetomidine. EEG was recorded for at least 60 min using a quantitative EEG (qEEG) bedside monitor. Amplitude-EEG (aEEG), relative spectral energy, alpha variation, and spectral entropy were recorded and compared before/after dexmedetomidine. Results. Sixty-three participants were enrolled. The relative spectral energy and alpha variation were not different before and after the use of dexmedetomidine (P> .05). The amplitude of the upper and lower boundaries in aEEG and spectral entropy were significantly lower after light sedation with dexmedetomidine compared with before (P< .05). When grouped according to the Glasgow Coma Scale (GCS), the amplitude of qEEG in participants with moderate GCS decreased significantly(P< .05), but not in mild or severe GCS. Conclusion. Relative spectral energy and alpha variation derived from qEEG could be used to evaluate the state of brain function even under light sedation with dexmedetomidine in severe patients during their ICU stay.

背景。床旁脑电图(EEG)可监测危重病人脑功能的变化。重症监护室(ICU)患者建议使用轻度镇静剂,但镇静剂可能会混淆脑电图读数。有关使用右美托咪定治疗重症患者脑电图变化的研究很少。本研究旨在探讨重症监护室重症患者使用右美托咪定前后的脑电图特征。方法。这项前瞻性研究招募了需要轻度镇静的重症脓毒症患者,我们使用右美托咪定对患者进行镇静。使用定量脑电图(qEEG)床旁监护仪记录至少 60 分钟的脑电图。记录并比较右美托咪定使用前后的振幅脑电图(aEEG)、相对频谱能量、α变异和频谱熵。结果。63 名参与者参加了研究。使用右美托咪定前后,相对频谱能量和阿尔法变化没有差异(P > .05)。使用右美托咪定进行轻度镇静后,aEEG 上下界振幅和频谱熵明显低于使用前(P .05)。根据格拉斯哥昏迷量表(GCS)分组时,中度 GCS 参与者的 qEEG 振幅明显下降(P .05),而轻度或重度 GCS 参与者的 qEEG 振幅则没有下降。结论即使在使用右美托咪定进行轻度镇静的情况下,重症患者在入住重症监护室期间的脑功能状态也可通过 qEEG 得出的相对频谱能量和α变异进行评估。
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引用次数: 0
Comparison of Spectral Analysis of Gamma Band Activity During Actual and Imagined Movements as a Cognitive Tool. 将实际运动和想象运动时伽马带活动的频谱分析作为一种认知工具进行比较。
IF 2 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-05-01 Epub Date: 2023-09-05 DOI: 10.1177/15500594231197100
Jitendra Kumawat, Anuradha Yadav, Kavita Yadav, Kusum Lata Gaur

Background. Imagined motor movement is a cognitive process in which a subject imagines a movement without doing it, which activates similar brain regions as during actual motor movement. Brain gamma band activity (GBA) is linked to cognitive functions such as perception, attention, memory, awareness, synaptic plasticity, motor control, and Imagination. Motor imagery can be used in sports to improve performance, raising the possibility of using it as a rehabilitation method through brain plasticity through mirror neurons. Method. A comparative observational study was conducted on 56 healthy male subjects after obtaining clearance from the Ethics Committee. EEG recordings for GBA were taken for resting, real, and imaginary motor movements and compared. The power spectrum of gamma waves was analyzed using the Kruskal-Wallis test; a p-value <.05 was considered significant. Results. The brain gamma rhythm amplitude was statistically increased during both actual and imaginary motor movement compared to baseline (resting stage) in most of the regions of the brain except the occipital region. There was no significant difference in GBA between real and imaginary movements. Conclusions. Increased gamma rhythm amplitude during both actual and imaginary motor movement than baseline (resting stage) indicating raised brain cognitive activity during both types of movements. There was no potential difference between real and imaginary movements suggesting that the real movement can be replaced by the imaginary movement to enhance work performance through mirror therapy.

背景介绍想象运动是一种认知过程,受试者在不做动作的情况下想象一个动作,这会激活与实际运动时相似的大脑区域。大脑伽马带活动(GBA)与感知、注意力、记忆、意识、突触可塑性、运动控制和想象等认知功能有关。运动想象可用于体育运动,以提高运动成绩,并有可能通过镜像神经元的大脑可塑性将其用作一种康复方法。研究方法在获得伦理委员会批准后,我们对 56 名健康男性受试者进行了比较观察研究。对静息、真实和想象的运动动作进行脑电图记录并进行比较。使用 Kruskal-Wallis 检验分析了伽玛波的功率谱;P 值 结果。据统计,与基线(静息阶段)相比,在实际运动和想象运动时,除枕叶区外,大部分脑区的脑伽马节律振幅都有所增加。实际运动和想象运动之间的伽马节律无明显差异。结论与基线(静息阶段)相比,实际运动和想象运动时的伽马节律振幅都有所增加,这表明这两种运动时大脑的认知活动都有所提高。实际运动和想象运动之间没有潜在的差异,这表明可以通过镜像疗法用想象运动代替实际运动来提高工作表现。
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引用次数: 0
Proactive and Reactive Inhibitory Control Strategies: Exploring the Impact of Interindividual Variables on an ERP Continuous Performance Task (AX-CPT). 前瞻性和反应性抑制控制策略:探索个体间变量对ERP连续表现任务(AX-CPT)的影响。
IF 2 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-05-01 Epub Date: 2022-12-22 DOI: 10.1177/15500594221145905
Elisa Schröder, Anais Ingels, Alexandru Dumitrescu, Charles Kornreich, Salvatore Campanella

According to the Dual Mechanisms of Control (DMC) framework, cognitive control can be divided into two strategies: proactive cognitive control, which relies mainly on the active maintenance of contextual information relevant to the ongoing task; and reactive cognitive control, which is a form of transient control triggered by an external cue. Although cognitive control has been studied extensively, little is known about the specificities of inhibition within the framework of the DMC model and the influence of interindividual variables on inhibitory control.Thanks to an inhibitory version of the continuous performance task (CPT), we studied behavioral performances and Event-Related Potentials (ERPs) related to proactive and reactive inhibition, and their links to psychological profile and cognitive performances. One hundred and five young adults underwent the task, along with a short clinical and cognitive evaluation.We were able to observe ERPs related to proactive (cue-N1, cue-N2, cue-P3, and the contingent negative variation) and reactive inhibitory control (target-N2 and target-P3). Our results showed that proactive strategies appeared to be linked with impulsivity, working memory abilities, dominant response inhibition, gender, and the consumption pattern of nicotine. Reactive strategies appeared to be linked with attentional and working memories abilities.Overall, the inhibitory AX-CPT allowed a specific investigation of cognitive control within the framework of the DMC based on behavioral and ERP variables. This provided us an opportunity to investigate the principal ERP components related to proactive and reactive inhibitory control strategies as well as to link them with specific clinical and cognitive variables.

根据 "双重控制机制"(DMC)框架,认知控制可分为两种策略:主动认知控制和被动认知控制。前者主要依赖于主动保持与当前任务相关的情境信息;后者则是一种由外部线索触发的瞬时控制形式。尽管认知控制已被广泛研究,但人们对 DMC 模型框架内抑制的特异性以及个体间变量对抑制控制的影响却知之甚少。借助抑制性版本的连续表现任务(CPT),我们研究了与主动和反应性抑制相关的行为表现和事件相关电位(ERP),以及它们与心理状况和认知表现的联系。我们能够观察到与主动(提示-N1、提示-N2、提示-P3和或然负变异)和反应性抑制控制(目标-N2和目标-P3)相关的ERPs。我们的研究结果表明,主动策略似乎与冲动、工作记忆能力、优势反应抑制、性别和尼古丁消费模式有关。总之,抑制性 AX-CPT 可以根据行为和 ERP 变量,在 DMC 框架内对认知控制进行具体研究。这让我们有机会研究与主动和被动抑制控制策略相关的主要ERP成分,并将它们与特定的临床和认知变量联系起来。
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引用次数: 0
Original Research: Clinical Significance of a Unique Pediatric EEG Configuration: Bi-Frontal Spikes With Simultaneous Bi-Occipital Positivity 原创研究:独特儿科脑电图配置的临床意义:双额叶尖峰与双枕叶同时阳性
IF 2 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-04-13 DOI: 10.1177/15500594241246505
Jacqueline Crawford, Cassie McFarlane, Anita N Datta
Introduction: Frontal-predominant epileptiform discharges (EDs) include generalized spike-wave (GSW) and frontal spikes (FS). However, negative bi-frontal ED with simultaneous occipital positivity (BFOD) are rare, leading to questions regarding physiological generators. Methods: To determine the clinical significance of BFOD, electroclinical features of children with BFOD (n = 40) were compared to control patients with GSW (n = 102) and FS (n = 100). Results: Results are presented in the following order: BFOD, GSW, and FS. Epilepsy was prevalent among the groups: 95.0%, 90.2%, and 77.0%, respectively. The median age of seizure-onset did not significantly differ between groups: 3.00, 4.00, and 2.25 years, respectively. Regarding EEG background features, the BFOD group had more disorganized sleep architecture than other groups, P < .005. There was a significant difference in the proportion of developmental delay (DD) between the groups ( P < .005). BFOD had much higher odds of DD compared to GSW and FS groups: odds ratio (OR) (confidence interval [CI]) 19.44 [5.64, 64.05] and 3.98 [1.16, 13.34]. Furthermore, BFOD had much higher odds of severe DD compared to GSW and FS groups: 9.60 [2.75, 33.45] and 2.73 [1.03, 7.27]. A Gross Motor Function Classification System (GMFCS) score of ≥ 4 was more prevalent in BFOD (22.5%), than GSW (0%) and FS groups (9%). On neuroimaging, BFOD had more structural ( P < .005) and multilobar structural ( P < .05) abnormalities than control groups. Conclusion: Children with BFOD had particularly severe significant DD, considerable motor deficit (GMFCS ≥ 4), and brain structural abnormalities, often multilobar. This suggests BFOD is a marker of severe underlying brain dysfunction and not benign when encountered on routine EEG review.
简介以额叶为主的癫痫样放电(ED)包括泛化尖波(GSW)和额叶尖波(FS)。然而,双额叶负性放电同时伴有枕叶阳性(BFOD)的情况非常罕见,这就引起了有关生理发生因素的问题。方法:为了确定 BFOD 的临床意义,将 BFOD 儿童(n = 40)的电临床特征与 GSW(n = 102)和 FS(n = 100)的对照组患者进行了比较。结果如下结果按以下顺序排列:BFOD、GSW 和 FS。各组癫痫发病率分别为 95.0%、90.2% 和 77.0%。各组的癫痫发作年龄中位数差异不大:分别为 3.00 岁、4.00 岁和 2.25 岁。在脑电图背景特征方面,BFOD 组的睡眠结构紊乱程度高于其他组,P < .005。各组之间发育迟缓(DD)的比例存在明显差异(P < .005)。与 GSW 组和 FS 组相比,BFOD 患发育迟缓的几率要高得多:几率比(OR)(置信区间 [CI])分别为 19.44 [5.64, 64.05] 和 3.98 [1.16, 13.34]。此外,与 GSW 组和 FS 组相比,BFOD 患严重残疾的几率要高得多:分别为 9.60 [2.75, 33.45] 和 2.73 [1.03, 7.27]。粗大运动功能分级系统(GMFCS)评分≥4分在BFOD(22.5%)中比GSW(0%)和FS组(9%)更普遍。在神经影像学方面,BFOD 比对照组有更多的结构(P < .005)和多叶结构(P < .05)异常。结论患有BFOD的儿童有特别严重的显著DD、相当程度的运动障碍(GMFCS ≥ 4)和脑结构异常,通常为多叶结构异常。这表明 BFOD 是严重潜在脑功能障碍的标志,在常规脑电图检查中并非良性。
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引用次数: 0
Central Auditory Changes Associated with Age-related Hearing Loss 与老年性听力损失有关的中枢听觉变化
IF 2 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-04-03 DOI: 10.1177/15500594241243116
Selhan Gürkan, Oğuz Başokçu, Serpil Mungan Durankaya, Yalçın İşler, Günay Kırkım
Objective. This study aimed to investigate age-related changes in cortical auditory evoked potentials (CAEPs) while considering three crucial factors: aging, high-frequency hearing loss and sensation level of the CAEP stimulus. Method. The electrophysiological and audiometric data of 71 elderly participants were analyzed using multiple regression analysis to investigate the association of CAEPs with the factors of aging, high-frequency hearing loss and sensation level of the CAEP test stimulus. Results. Aging was significantly associated with prolonged N1 and P2 latencies and reduced P2 amplitude. Elevated thresholds related to the sensation level of the CAEP stimulus were significantly associated with increased N1 and P2 amplitudes and decreased N1 latency. A significant relationship was detected between high-frequency hearing thresholds and the shortening of P2 latencies and the reduction of P2 amplitudes. Conclusion. The results of this study highlight the complex interplay of aging, high-frequency hearing loss and the sensation level of the CAEP stimulus on CAEP components in elderly people. These factors should be considered in future research using CAEPs to enhance overall understanding of auditory processing in the aging population.
研究目的本研究旨在探讨皮层听觉诱发电位(CAEPs)与年龄相关的变化,同时考虑三个关键因素:年龄、高频听力损失和 CAEPs 刺激的感觉水平。研究方法采用多元回归分析法对71名老年参与者的电生理和听力数据进行分析,研究CAEPs与年龄、高频听力损失和CAEP测试刺激感觉水平等因素的关系。结果发现衰老与 N1 和 P2 潜伏期的延长以及 P2 振幅的减小明显相关。与 CAEP 刺激感觉水平相关的阈值升高与 N1 和 P2 振幅增大和 N1 延迟减小明显相关。高频听阈与 P2 潜伏期缩短和 P2 振幅减小之间存在明显关系。结论本研究的结果凸显了衰老、高频听力损失和 CAEP 刺激的感觉水平对老年人 CAEP 成分的复杂相互作用。在今后使用 CAEPs 进行研究时,应考虑这些因素,以加深对老年人听觉处理过程的全面了解。
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引用次数: 0
High-Density (HD) Scalp EEG Findings in "Benign" Childhood Epilepsy with Centrotemporal Spikes (BCECTS). 颞叶中心棘波 "良性 "儿童癫痫 (BCECTS) 的高密度 (HD) 头皮脑电图结果。
IF 2 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-03-01 Epub Date: 2022-12-14 DOI: 10.1177/15500594221145265
Sonal Bhatia, Andrew Todd Ham, Ekrem Kutluay

Despite characteristic clinical and scalp EEG findings, BCECTS pathophysiology is unclear regarding involvement of large-scale neuronal networks. Higher number of scalp electrodes with HD-EEG may promote accurate localization of the cortical generators in BCECTS providing additional insight in those with neurocognitive problems. We aimed to determine the value of visual interpretation of topographical maps using 256 channels (when compared to standard 21 channel array) HD-EEG in BCECTS and attempted to source localize interictal discharges (IEDs) using Geosource 2 software. Patient records were reviewed for demographic, seizure, brain magnetic resonance imaging (MRI) details; scalp and HD-EEG findings. HD-EEG software was used to review raw EEG data (21 scalp EEG electrodes were compared to 256 HD-EEG electrodes); select, average, and source localize IEDs.Five BCECTS patients with HD-EEG were identified. Seizure onset age ranged from 5-11 years with 1-18 lifetime seizures; both focal (n = 3) and focal to bilateral tonic-clonic (n = 2). Neurocognitive co-morbidities noted in our cohort included attention deficit hyperactivity disorder, speech/developmental delay and a specific learning disorder. Scalp EEG showed typical findings with IEDs over the centrotemporal regions (bilateral n = 3; unilateral n = 2). Visualization and inspection of expanded coverage topographic maps with HD-EEG showed well-defined islands of maximum negativity and positivity of a dipole compared to conventional channels where boundary delineation was obscured. Further, HD-EEG localized IEDs/"spike-generator" to areas such as the pre-and post-central, middle-frontal and temporal gyrus, and the inferior parietal lobule. In BCECTS, HD-EEG may show affection for a broader neural network and may provide a better insight into the associated neurocognitive morbidities.

尽管有特征性的临床和头皮脑电图发现,但 BCECTS 的病理生理学还不清楚大规模神经元网络的参与情况。使用 HD-EEG 的更多头皮电极可能会促进 BCECTS 中皮质发生器的准确定位,从而为有神经认知问题的患者提供更多的洞察力。我们旨在确定在 BCECTS 中使用 256 通道(与标准 21 通道阵列相比)HD-EEG 可视化解读地形图的价值,并尝试使用 Geosource 2 软件对发作间期放电 (IED) 进行源定位。对患者病历中的人口统计学、癫痫发作、脑磁共振成像 (MRI) 详情、头皮和 HD-EEG 结果进行了审查。使用 HD-EEG 软件查看原始脑电图数据(将 21 个头皮脑电图电极与 256 个 HD-EEG 电极进行比较);选择、平均和源定位 IED。癫痫发作的发病年龄为 5-11 岁,终生癫痫发作次数为 1-18 次;既有局灶性癫痫发作(3 次),也有局灶性至双侧强直阵挛性癫痫发作(2 次)。本组患者的神经认知并发症包括注意力缺陷多动障碍、言语/发育迟缓和特殊学习障碍。头皮脑电图显示典型的颞中区IED(双侧n = 3;单侧n = 2)。使用 HD-EEG 对扩大覆盖范围的地形图进行观察和检查后发现,与边界划分不清的传统通道相比,偶极子的最大负性和正性岛清晰明确。此外,HD-EEG 还将 IED/"尖峰发生器 "定位在中央前回和中央后回、额叶中回和颞叶以及顶叶下回等区域。在 BCECTS 中,HD-EEG 可能会显示出更广泛的神经网络,并能更好地了解相关的神经认知病症。
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引用次数: 0
Connectivity Disturbances in Self-Limited Epilepsy with Centrotemporal Spikes: A Partial Directed Coherence Analysis of Electroencephalogram. 自限性癫痫与中心颞区棘波的连接紊乱:脑电图的部分定向相干性分析。
IF 2 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-03-01 Epub Date: 2023-05-25 DOI: 10.1177/15500594231177979
Ching-Tai Chiang, Rei-Cheng Yang, Yu-Chia Kao, Rong-Ching Wu, Chen-Sen Ouyang, Lung-Chang Lin

Although the remission of self-limited epilepsy with centrotemporal spikes (SeLECTS) usually occurs by adolescence, deficits in cognition and behavior are not uncommon. Several functional magnetic resonance imaging (fMRI) studies have revealed connectivity disturbances in patients with SeLECTS associated with cognitive impairment. However, the disadvantages of fMRI are expensive, time-consuming, and motion sensitive. In the current study, we used a partial directed coherence (PDC) method to analyze electroencephalogram (EEG) for exploring brain connectivity in patients with SeLECTS. This study enrolled 38 participants (19 patients with SeLECTS and 19 healthy controls) for PDC analysis. Our results demonstrated that the controls had significantly higher PDC inflow connectivity in the F7, T3, FP1, and F8 channels than patients with SeLECTS. By contrast, the patients with SeLECTS demonstrated significantly higher PDC inflow connectivity than did the controls in the T5, Pz, and P4 channels. We also compared the PDC connectivity in different Brodmann areas between the patients with SeLECTS and the controls. The results revealed that the inflow connectivity in the BA9_46_L area was significantly higher in the controls than in the patients with SeLECTS, whereas the inflow connectivity in the MIF_L area 4 was significantly higher in the patients with SeLECTS than in the controls. Our proposed approach of combining EEG with PDC provides a convenient and useful tool for investigating functional connectivity in patients with SeLECTS. This approach is time-saving and inexpensive compared with fMRI, but it achieves similar results to fMRI.

虽然伴有颞中心棘波的自限性癫痫(SeLECTS)通常会在青春期缓解,但认知和行为障碍并不少见。多项功能磁共振成像(fMRI)研究显示,SeLECTS 患者的连接紊乱与认知障碍有关。然而,fMRI 的缺点是昂贵、耗时和对运动敏感。在本研究中,我们使用了部分定向相干(PDC)方法来分析脑电图(EEG),以探索 SeLECTS 患者的大脑连接性。本研究招募了 38 名参与者(19 名 SeLECTS 患者和 19 名健康对照者)进行 PDC 分析。结果表明,对照组在 F7、T3、FP1 和 F8 通道的 PDC 流入连接性明显高于 SeLECTS 患者。相比之下,SeLECTS 患者在 T5、Pz 和 P4 通道的 PDC 流入连通性明显高于对照组。我们还比较了 SeLECTS 患者与对照组之间不同 Brodmann 区域的 PDC 连接性。结果显示,对照组 BA9_46_L 区域的流入连通性明显高于 SeLECTS 患者,而 SeLECTS 患者 MIF_L 4 区域的流入连通性明显高于对照组。我们提出的将脑电图与 PDC 相结合的方法为研究 SeLECTS 患者的功能连接性提供了一种方便实用的工具。与 fMRI 相比,这种方法省时且成本低廉,但却能获得与 fMRI 相似的结果。
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引用次数: 0
The Prevalence and Risk Factors of Electrical Status Epilepticus During Slow-Wave Sleep in Self-Limited Epilepsy With Centrotemporal Spikes. 伴有中心颞区棘波的自限性癫痫患者慢波睡眠时电癫痫状态的发生率和风险因素
IF 2 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-03-01 Epub Date: 2023-06-18 DOI: 10.1177/15500594231182758
Guangshuang Lu, Yun Cheng, Yun Wang, Jie Hu, Fan Zhang, Wenbo Li, Minnong Xia, Xiaoyan Lu, Wu Yang

Objective. To investigate the prevalence and risk factors for electrical status epilepticus during slow-wave sleep (ESES) in patients with self-limited epilepsy with centrotemporal spikes (SeLECTS). Methods. The clinical and follow-up data of children with SeLECTS were collected between 2017 and 2021. Patients were divided into typical ESES, atypical ESES, and non-ESES groups according to spike-wave indices (SWI). Clinical and electroencephalography characteristics were retrospectively analyzed. Logistic regression was used to identify risk factors for ESES. Results. A total of 95 patients with SeLECTS were enrolled. Seven patients (7.4%) developed typical ESES, 30 (31.6%) developed atypical ESES, 25 (26.3%) developed ESES at the first visit, and 12 (12.6%) developed ESES during treatment and follow-up. Multivariate logistic regression analysis showed that the risk factors for SeLECTS combined with ESES were Rolandic double or multiple spikes (OR = 8.626, 95% CI: 2.644-28.147, P < .001) and Rolandic slow waves (OR = 53.550, 95% CI: 6.339-452.368, P < .001). There were no significant differences in seizure characteristics, electroencephalogram (EEG) findings, or cognitive impairment between the atypical and typical ESES groups. Conclusion. More than one-third of the SeLECTS patients combined with ESES. Both atypical and typical ESES scores can affect cognitive function. On electroencephalography, interictal Rolandic double/multiple spikes and slow-wave abnormalities may indicate SeLECTS with ESES.

研究目的调查自限性癫痫伴颞叶中心棘波(SeLECTS)患者在慢波睡眠中电癫痫状态(ESES)的发生率和风险因素。研究方法收集了2017年至2021年间SeLECTS患儿的临床和随访数据。根据尖波指数(SWI)将患者分为典型ESES组、非典型ESES组和非ESES组。对临床和脑电图特征进行了回顾性分析。采用逻辑回归法确定ESES的风险因素。结果共有 95 名 SeLECTS 患者入选。7名患者(7.4%)出现典型ESES,30名患者(31.6%)出现非典型ESES,25名患者(26.3%)在首次就诊时出现ESES,12名患者(12.6%)在治疗和随访期间出现ESES。多变量逻辑回归分析显示,SeLECTS合并ESES的风险因素是罗兰尼克双峰或多峰(OR = 8.626,95% CI:2.644-28.147,P P 结论。超过三分之一的 SeLECTS 患者合并有 ESES。非典型和典型 ESES 评分都会影响认知功能。在脑电图上,发作间期罗兰双/多棘波和慢波异常可能预示着 SeLECTS 合并 ESES。
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引用次数: 0
Abdominal Compartment Syndrome with Super-K (Ketamine) for Super-R(efractory) Status Epilepticus: A Case Report. 腹腔隔室综合征用超k(氯胺酮)治疗超r(难治性)癫痫持续状态:1例报告。
IF 2 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-03-01 Epub Date: 2022-10-25 DOI: 10.1177/15500594221134920
Prashant A Natteru, Shoba Jayaram, Oriana Sanchez, Kyla Leon, Aditi Mishra, Christa O'Hana Nobleza

Refractory status epilepticus is commonly defined as status epilepticus that fails to respond to two or more appropriately dosed intravenous anti-seizure medications including at least one non-benzodiazepine drug. Super-refractory status epilepticus (SRSE) is when status epilepticus continues for ≥24 h despite anesthetic treatment or recurs on an attempted wean of the anesthetic drugs. There is little evidence to guide the management of SRSE. Of late, unconventional therapies have been described in the literature regarding the management of SRSE, with ketamine leading the pack. Studies have noted ketamine's therapeutic efficacy up to 91% in SRSE cessation. Common side effects of ketamine include nausea, vomiting, headache, and hallucinations; but to our knowledge, ketamine has not been implicated in the pathogenesis of abdominal compartment syndrome. We describe a 74-year-old male who developed severe abdominal compartment syndrome in the setting of ketamine infusion for new-onset SRSE to increase awareness about this potential complication.

难治性癫痫持续状态通常被定义为对两种或两种以上适当剂量的静脉内抗癫痫药物(包括至少一种非苯二氮卓类药物)没有反应的癫痫持续状态。超难治性癫痫持续状态(SRSE)是指尽管进行了麻醉治疗,但癫痫持续状态仍持续≥24小时,或在尝试戒除麻醉药物后复发。几乎没有证据可以指导SRSE的管理。最近,关于SRSE管理的文献中描述了非常规疗法,其中氯胺酮占主导地位。研究表明,氯胺酮在SRSE停止中的治疗效果高达91%。氯胺酮常见的副作用包括恶心、呕吐、头痛和幻觉;但据我们所知,氯胺酮尚未参与腹腔隔室综合征的发病机制。我们描述了一名74岁的男性,他在新发SRSE患者输注氯胺酮的过程中出现了严重的腹腔室综合征,以提高对这种潜在并发症的认识。
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引用次数: 0
Ictal EEG: Etiology and Mortality in Older Adults With Nonconvulsive Status Epilepticus. 异位脑电图:老年非惊厥性癫痫状态患者的病因和死亡率。
IF 2 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-03-01 Epub Date: 2023-07-27 DOI: 10.1177/15500594231183554
Glória M A S Tedrus

Clinical-electroencephalogram (EEG), as well as etiological and prognostic data on subtypes of nonconvulsive status epilepticus (NCSE) are yet to be established. Objective: Evaluate the clinical semiology and EEG findings and prognostic data of older adults with NCSE. Methodology: Characterize the clinical-EEG and prognostic data in the subtypes of NCSE in older adults consecutively admitted to the emergency room of the Pontifícia Universidade Católica de Campinas (PUC-Campinas) University Hospital. Results: When evaluating 105 older adults with altered consciousness, it was possible to diagnose NCSE in 50 (47.6%) older adults, with a mean age of 72.8 ± 8.8 years. NCSE-coma occurred in 6 cases, with NCSE-without coma in 44 cases. The etiology was structural in 41(82%) cases, metabolic in 5 cases, and unknown etiology in 4 cases. Twelve cases had a history of epileptic seizures. On the EEG, epileptiform discharges (EDs > 2.5 Hz) were present in 34(68%) cases and rhythmic delta activity /lateralized periodic patterns occurred in 35(70%) cases. There was clinical improvement after the initial pharmacological treatment in 36 cases and, within 30 days, 18 cases died. The better prognosis was associated with a good response to initial pharmacological treatment (n = 14) and with EDs > 2.5 Hz on EEG (Fisher's exact test; 26 vs 8; P = .012). Conclusion: Focal NCSE with impaired consciousness was the most frequent subtype. The most frequent finding on the EEG was the recording of focal/regional seizures. A high number of cases showed initial clinical improvement, but mortality was high. The favorable prognosis was associated with initial clinical improvement and the presence of EDs > 2.5 Hz. There was no relationship between EEG patterns and the etiology and subtypes of NCSE in older adults.

关于非惊厥性癫痫(NCSE)亚型的临床脑电图(EEG)、病因学和预后数据尚未确定。研究目的评估患有 NCSE 的老年人的临床半身像和脑电图结果以及预后数据。方法:对临床-脑电图的特征进行分析:分析坎皮纳斯天主教大学(PUC-Campinas)大学医院急诊室连续收治的 NCSE 亚型老年人的临床、EEG 和预后数据。研究结果在对 105 名意识改变的老年人进行评估时,有 50 名(47.6%)老年人被诊断为 NCSE,平均年龄为 72.8 ± 8.8 岁。6例发生了NCSE-昏迷,44例发生了NCSE-无昏迷。41例(82%)病因是结构性的,5例是代谢性的,4例病因不明。12 例患者有癫痫发作史。在脑电图上,34 例(68%)患者出现痫样放电(EDs > 2.5 Hz),35 例(70%)患者出现节律性三角活动/偏侧周期性模式。有 36 例患者在接受初始药物治疗后临床症状有所改善,但有 18 例患者在 30 天内死亡。较好的预后与对初始药物治疗的良好反应(n = 14)和脑电图上 EDs > 2.5 Hz 有关(费雪精确检验;26 vs 8;P = .012)。结论伴有意识障碍的局灶性 NCSE 是最常见的亚型。脑电图最常见的发现是记录到局灶性/区域性癫痫发作。很多病例在初期临床症状有所改善,但死亡率很高。良好的预后与最初的临床改善和ED > 2.5 Hz有关。老年人的脑电图模式与 NCSE 的病因和亚型之间没有关系。
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Clinical EEG and Neuroscience
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