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Altered Dynamic Brain Connectivity in Individuals With Sickle Cell Disease and Chronic Pain Secondary to Hip Osteonecrosis. 镰状细胞病和髋关节骨坏死继发慢性疼痛患者动态脑连接改变
IF 2 4区 医学 Q2 Medicine Pub Date : 2023-05-01 DOI: 10.1177/15500594211054297
Jamille Evelyn R S Santana, Abrahão F Baptista, Rita Lucena, Tiago da S Lopes, Raphael S do Rosário, Marjorie R Xavier, André Fonseca, José Garcia V Miranda

Individuals with sickle cell disease (SCD) exhibit changes in static brain connectivity in rest. However, little known as chronic pain associated with hip osteonecrosis affects dynamic brain connectivity during rest and the motor imagery task. The aim of this study was to investigate the characteristics of the dynamic functional brain connectivity of individuals with SCD and chronic pain secondary to hip osteonecrosis. This is a cross-sectional study comparing the dynamic brain connectivity of healthy individuals (n = 18) with the dynamic brain connectivity of individuals with SCD and chronic pain (n = 22). Individuals with SCD and chronic pain were stratified into high- or low-intensity pain groups based on pain intensity at the time of assessment. Dynamic brain connectivity was assessed through electroencephalography in 3 stages, resting state with eyes closed, and during hip (painful for the SCD individuals) and hand (control, nonpainful) motor imagery. Average weight of the edges and full synchronization time (FST)-time required for 95% of the possible edges to appear over time during a given task-were evaluated. Regarding the average weight of the edges, individuals with SCD and high-intensity pain presented higher edge weight during hip motor imagery. The average weight of the edges correlated positively with pain intensity and depression symptoms. Individuals with SCD and chronic pain complete the cerebral network at rest more quickly (lower FST). Individuals with SCD and chronic pain/hip osteonecrosis have impaired dynamic brain network with shorter FST in rest network and more pronounced diffuse connectivity in individuals with high-intensity pain. The dynamic brain network evaluated by time-varying graphs and motif synchronization was able to identify differences between groups.

患有镰状细胞病(SCD)的个体在休息时表现出静态大脑连接的变化。然而,鲜为人知的是,与髋部骨坏死相关的慢性疼痛会影响休息和运动想象任务期间的动态大脑连接。本研究的目的是探讨SCD和髋关节骨坏死继发慢性疼痛患者的动态功能脑连接特征。这是一项横断面研究,比较了健康个体(n = 18)和慢性疼痛SCD患者(n = 22)的动态脑连通性。根据评估时的疼痛强度,SCD和慢性疼痛患者被分为高强度或低强度疼痛组。通过3个阶段的脑电图评估动态脑连通性,闭眼静息状态,以及髋关节(SCD个体疼痛)和手部(对照,无疼痛)运动想象。评估了边缘的平均权重和完全同步时间(FST)-在给定任务中随时间推移95%的可能边缘出现所需的时间。关于边缘的平均重量,SCD和高强度疼痛的个体在髋关节运动成像中表现出更高的边缘重量。边缘的平均权重与疼痛强度和抑郁症状呈正相关。患有SCD和慢性疼痛的个体在休息时完成大脑网络的速度更快(FST较低)。患有SCD和慢性疼痛/髋关节骨坏死的个体动态脑网络受损,静止网络FST较短,高强度疼痛个体弥漫性连接更明显。动态脑网络通过时变图和基序同步来评估,能够识别组间差异。
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引用次数: 4
Early Neuroprognostication Using Frontal Spectrograms in Moderately Sedated Cardiac Arrest Patients. 中度镇静心脏骤停患者额叶谱的早期神经预后。
IF 2 4区 医学 Q2 Medicine Pub Date : 2023-05-01 DOI: 10.1177/15500594221074888
Jae Hoon Lee

Introduction. The integrated suppression ratio throughout all electroencephalography (EEG) patterns has rarely been studied. The aim of this study was to evaluate the clinical utility of the suppression ratio and hyperactivity of EEG on spectrograms. Methods. This prospective observational study included 73 cardiac arrest patients. Hardwired frontal EEG monitoring with spectrograms (color density spectral arrays, CDSA) was used to predict neurological outcomes. The mean suppression ratio (MSR) and hyperactivity in the high-frequency band (HHF) in the spectrogram were investigated in moderately sedated patients. Sedative doses were considered to estimate the MSR, which was automatically measured. Results. Using propofol 30 to 40 µg/kg/min and remifentanil 0.1 to 0.15 µg/kg/min, all the patients with an MSR >30% died. At day 2, the MSR in patients with a good outcome was 0%. The cut off values were different as an MSR >30% at day 1 (AUC 0.815) and an MSR >1% at day 2 (AUC 0.891). Of the patients with an MSR ≤30%, HHF was the greatest predictor of a poor outcome (OR 12.858, P = .006). The best predictors of a poor outcome using the spectrogram were suppression ratio (SR) >30% or HHF at day 1 (AUC 0.88) and SR >1% or HHF at day 2 (AUC 0.909). Conclusions. The use of MSR and HHF in frontal spectrograms is convenient and may be successfully employed for early neuroprognostication in moderately sedated cardiac arrest patients. However, spectrograms should be used with electroencephalogram considering the effects of sedatives because of the imperfect detection of electrographic seizures and artifacts.

介绍。所有脑电图(EEG)模式的综合抑制比很少被研究。本研究的目的是评估脑电图频谱抑制比和多动的临床应用。方法。这项前瞻性观察性研究包括73例心脏骤停患者。硬连线额叶脑电图监测与频谱图(彩色密度谱阵列,CDSA)用于预测神经预后。研究了中度镇静患者的平均抑制比(MSR)和频谱图中高频带(HHF)的高活动性。使用镇静剂剂量来估计MSR, MSR是自动测量的。结果。使用异丙酚30 ~ 40µg/kg/min,瑞芬太尼0.1 ~ 0.15µg/kg/min, MSR >30%的患者全部死亡。在第2天,预后良好的患者的MSR为0%。切断值不同,第1天的MSR >30% (AUC 0.815),第2天的MSR >1% (AUC 0.891)。在MSR≤30%的患者中,HHF是预后不良的最大预测因子(OR 12.858, P = 0.006)。使用谱图预测不良预后的最佳指标是第1天抑制比(SR) >30%或HHF (AUC 0.88)和第2天抑制比(SR) >1%或HHF (AUC 0.909)。结论。在额叶谱图中使用MSR和HHF是方便的,可以成功地用于中度镇静的心脏骤停患者的早期神经预后。然而,考虑到镇静剂的影响,频谱图应该与脑电图一起使用,因为电图癫痫发作和伪影的检测不完善。
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引用次数: 0
Borderline and Depression: A Thin EEG Line. 边缘和抑郁:一条细脑电图线。
IF 2 4区 医学 Q2 Medicine Pub Date : 2023-05-01 DOI: 10.1177/15500594211060830
Jakša Vukojević, Damir Mulc, Ivana Kinder, Eda Jovičić, Krešimir Friganović, Aleksandar Savić, Mario Cifrek, Domagoj Vidović

In everyday clinical practice, there is an ongoing debate about the nature of major depressive disorder (MDD) in patients with borderline personality disorder (BPD). The underlying research does not give us a clear distinction between those 2 entities, although depression is among the most frequent comorbid diagnosis in borderline personality patients. The notion that depression can be a distinct disorder but also a symptom in other psychopathologies led our team to try and delineate those 2 entities using 146 EEG recordings and machine learning. The utilized algorithms, developed solely for this purpose, could not differentiate those 2 entities, meaning that patients suffering from MDD did not have significantly different EEG in terms of patients diagnosed with MDD and BPD respecting the given data and methods used. By increasing the data set and the spatiotemporal specificity, one could have a more sensitive diagnostic approach when using EEG recordings. To our knowledge, this is the first study that used EEG recordings and advanced machine learning techniques and further confirmed the close interrelationship between those 2 entities.

在日常临床实践中,关于边缘型人格障碍(BPD)患者的重度抑郁障碍(MDD)的性质一直存在争议。尽管抑郁症是边缘型人格患者中最常见的合并症之一,但基础研究并没有给我们这两种实体之间的明确区别。抑郁症可以是一种独特的疾病,但也可以是其他精神病理学的症状,这一概念促使我们的团队尝试使用146个脑电图记录和机器学习来描述这两种实体。所使用的算法仅为此目的而开发,无法区分这两种实体,这意味着在给定的数据和使用的方法下,MDD患者的脑电图与诊断为MDD和BPD的患者没有显著差异。通过增加数据集和时空特异性,可以在使用脑电图记录时获得更敏感的诊断方法。据我们所知,这是第一个使用脑电图记录和先进机器学习技术的研究,并进一步证实了这两个实体之间的密切相互关系。
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引用次数: 0
Pitfalls in EEG Analysis in Patients With Nonconvulsive Status Epilepticus: A Preliminary Study. 非惊厥性癫痫持续状态患者脑电图分析的缺陷:初步研究。
IF 2 4区 医学 Q2 Medicine Pub Date : 2023-05-01 DOI: 10.1177/15500594211050492
Ying Wang, Ivan C Zibrandtsen, Richard H C Lazeron, Johannes P van Dijk, Xi Long, Ronald M Aarts, Lei Wang, Johan B A M Arends
Objective: Electroencephalography (EEG) interpretations through visual (by human raters) and automated (by computer technology) analysis were still not reliable for the diagnosis of nonconvulsive status epilepticus (NCSE). This study aimed to identify typical pitfalls in the EEG analysis and make suggestions as to how those pitfalls might be avoided. Methods: We analyzed the EEG recordings of individuals who had clinically confirmed or suspected NCSE. Epileptiform EEG activity during seizures (ictal discharges) was visually analyzed by 2 independent raters. We investigated whether unreliable EEG visual interpretations quantified by low interrater agreement can be predicted by the characteristics of ictal discharges and individuals’ clinical data. In addition, the EEG recordings were automatically analyzed by in-house algorithms. To further explore the causes of unreliable EEG interpretations, 2 epileptologists analyzed EEG patterns most likely misinterpreted as ictal discharges based on the differences between the EEG interpretations through the visual and automated analysis. Results: Short ictal discharges with a gradual onset (developing over 3 s in length) were liable to be misinterpreted. An extra 2 min of ictal discharges contributed to an increase in the kappa statistics of >0.1. Other problems were the misinterpretation of abnormal background activity (slow-wave activities, other abnormal brain activity, and the ictal-like movement artifacts), continuous interictal discharges, and continuous short ictal discharges. Conclusion: A longer duration criterion for NCSE-EEGs than 10 s that is commonly used in NCSE working criteria is recommended. Using knowledge of historical EEGs, individualized algorithms, and context-dependent alarm thresholds may also avoid the pitfalls.
目的:脑电图(EEG)通过视觉(人工评分)和自动(计算机技术)分析对非惊厥性癫痫持续状态(NCSE)的诊断仍不可靠。本研究旨在识别脑电图分析中的典型缺陷,并就如何避免这些缺陷提出建议。方法:分析临床确诊或疑似NCSE患者的脑电图记录。癫痫样脑电图活动在癫痫发作(癫痫放电)由2个独立的评价者目视分析。我们研究了由低互译一致性量化的不可靠脑电图视觉解释是否可以通过初始放电特征和个人临床数据来预测。此外,脑电图记录由内部算法自动分析。为了进一步探讨脑电解释不可靠的原因,2名癫痫学家通过视觉分析和自动分析,根据脑电解释之间的差异,分析了最可能被误解为精神放电的脑电模式。结果:逐渐发作的短时间急症放电(持续时间超过3 s)容易被误解。额外2分钟的精神病发作导致kappa统计增加>0.1。其他问题还包括对异常背景活动(慢波活动、其他异常脑活动和类似峰时运动的伪影)、连续间歇放电和连续短峰时放电的误解。结论:推荐采用比NCSE工作标准10 s更长的NCSE- eeg持续时间标准。使用历史脑电图知识、个性化算法和与上下文相关的警报阈值也可以避免陷阱。
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引用次数: 1
Functional (un-)Coupling: Impairment, Compensation, and Future Progression in Alzheimer's Disease. 功能(非)耦合:阿尔茨海默病的损伤、补偿和未来进展。
IF 2 4区 医学 Q2 Medicine Pub Date : 2023-05-01 DOI: 10.1177/15500594211052208
Jochen A Mosbacher, Markus Waser, Heinrich Garn, Stephan Seiler, Carmina Coronel, Peter Dal-Bianco, Thomas Benke, Manfred Deistler, Gerhard Ransmayr, Florian Mayer, Guenter Sanin, Anita Lechner, Helmut K Lackner, Petra Schwingenschuh, Dieter Grossegger, Reinhold Schmidt

Background: Functional (un-)coupling (task-related change of functional connectivity) between different sites of the brain is a mechanism of general importance for cognitive processes. In Alzheimer's disease (AD), prior research identified diminished cortical connectivity as a hallmark of the disease. However, little is known about the relation between the amount of functional (un-)coupling and cognitive performance and decline in AD. Method: Cognitive performance (based on CERAD-Plus scores) and electroencephalogram (EEG)-based functional (un-)coupling measures (connectivity changes from rest to a Face-Name-Encoding task) were assessed in 135 AD patients (age: M = 73.8 years; SD = 9.0). Of these, 68 patients (M = 73.9 years; SD = 8.9) participated in a follow-up assessment of their cognitive performance 1.5 years later. Results: The amounts of functional (un-)coupling in left anterior-posterior and homotopic interhemispheric connections in beta1-band were related to cognitive performance at baseline (β = .340; p < .001; β = .274; P = .001, respectively). For both markers, a higher amount of functional coupling was associated with better cognitive performance. Both markers also were significant predictors for cognitive decline. However, while patients with greater functional coupling in left anterior-posterior connections declined less in cognitive performance (β = .329; P = .035) those with greater functional coupling in interhemispheric connections declined more (β = -.402; P = .010). Conclusion: These findings suggest an important role of functional coupling mechanisms in left anterior-posterior and interhemispheric connections in AD. Especially the complex relationship with cognitive decline in AD patients might be an interesting aspect for future studies.

背景:大脑不同部位之间的功能(非)耦合(功能连接的任务相关变化)是认知过程中普遍重要的机制。在阿尔茨海默病(AD)中,先前的研究确定皮质连通性减弱是该疾病的标志。然而,关于功能(非)偶联量与认知表现和AD下降之间的关系知之甚少。方法:评估135例AD患者的认知表现(基于CERAD-Plus评分)和基于脑电图(EEG)的功能(非)耦合测量(从休息到面孔-名称编码任务的连接变化)。sd = 9.0)。其中,68例患者(M = 73.9岁;SD = 8.9)在1.5年后对他们的认知表现进行随访评估。结果:β - 1带左前后半球连接和同位半球连接的功能性(非)偶联量与基线时的认知表现相关(β = 0.340;p =。001年,分别)。对于这两种标记,更高数量的功能耦合与更好的认知表现相关。这两项指标也是认知能力下降的重要预测指标。然而,当左前后连接功能耦合较大的患者认知能力下降较少(β = .329;P = 0.035),脑间连接功能耦合较大的患者脑功能衰退更严重(β = - 0.402;p = .010)。结论:这些发现提示AD左前后半球连接的功能耦合机制在AD左前后半球连接中起重要作用。特别是与AD患者认知能力下降的复杂关系可能是未来研究的一个有趣方面。
{"title":"Functional (un-)Coupling: Impairment, Compensation, and Future Progression in Alzheimer's Disease.","authors":"Jochen A Mosbacher,&nbsp;Markus Waser,&nbsp;Heinrich Garn,&nbsp;Stephan Seiler,&nbsp;Carmina Coronel,&nbsp;Peter Dal-Bianco,&nbsp;Thomas Benke,&nbsp;Manfred Deistler,&nbsp;Gerhard Ransmayr,&nbsp;Florian Mayer,&nbsp;Guenter Sanin,&nbsp;Anita Lechner,&nbsp;Helmut K Lackner,&nbsp;Petra Schwingenschuh,&nbsp;Dieter Grossegger,&nbsp;Reinhold Schmidt","doi":"10.1177/15500594211052208","DOIUrl":"https://doi.org/10.1177/15500594211052208","url":null,"abstract":"<p><p><b>Background:</b> Functional (un-)coupling (task-related change of functional connectivity) between different sites of the brain is a mechanism of general importance for cognitive processes. In Alzheimer's disease (AD), prior research identified diminished cortical connectivity as a hallmark of the disease. However, little is known about the relation between the amount of functional (un-)coupling and cognitive performance and decline in AD. <b>Method:</b> Cognitive performance (based on CERAD-Plus scores) and electroencephalogram (EEG)-based functional (un-)coupling measures (connectivity changes from rest to a Face-Name-Encoding task) were assessed in 135 AD patients (age: <i>M</i> = 73.8 years; <i>SD</i> = 9.0). Of these, 68 patients (<i>M</i> = 73.9 years; <i>SD</i> = 8.9) participated in a follow-up assessment of their cognitive performance 1.5 years later. <b>Results:</b> The amounts of functional (un-)coupling in left anterior-posterior and homotopic interhemispheric connections in beta1-band were related to cognitive performance at baseline (β = .340; <i>p</i> < .001; β = .274; <i>P</i> = .001, respectively). For both markers, a higher amount of functional coupling was associated with better cognitive performance. Both markers also were significant predictors for cognitive decline. However, while patients with greater functional coupling in left anterior-posterior connections declined less in cognitive performance (β = .329; <i>P</i> = .035) those with greater functional coupling in interhemispheric connections declined more (β = -.402; <i>P</i> = .010). <b>Conclusion:</b> These findings suggest an important role of functional coupling mechanisms in left anterior-posterior and interhemispheric connections in AD. Especially the complex relationship with cognitive decline in AD patients might be an interesting aspect for future studies.</p>","PeriodicalId":10682,"journal":{"name":"Clinical EEG and Neuroscience","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9630093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Electroencephalographic Microstates are Correlated with Global Functioning in Schizophrenia But Not in Bipolar Disorder. 脑电微观状态与精神分裂症的整体功能相关,但与双相情感障碍无关。
IF 2 4区 医学 Q2 Medicine Pub Date : 2023-05-01 DOI: 10.1177/15500594221098286
Pao-Huan Chen, Hsiao-Lun Ku, Jiunn-Kae Wang, Jiunn-Horng Kang, Tzu-Yu Hsu

Objectives. Microstate studies of electroencephalograms (EEGs) on schizophrenia (SCZ) and bipolar disorder (BD) demonstrated categorical differences. The relationship between microstate indices and clinical symptoms in each group, however, remained unclear. Our objective was to examine associations between EEG microstates and the core features of SCZ and BD. Methods. This study examined the resting EEG data of 40 patients with SCZ, 19 patients with BD (12 BD type I and 7 BD type II), and 16 healthy controls. EEG topographic maps were divided into four canonical microstate classes: A, B, C, and D. The Positive and Negative Syndrome Scale (PANSS), Young Mania Rating Scale, Hamilton Depression Rating Scale (HAMD), and Global Assessment of Functioning (GAF) were used to measure clinical symptoms and global functioning. Results. There was a significant inverse correlation between the proportion of time spent in microstate class A and GAF in patients with SCZ but not BD. Furthermore, the occurrence of microstate class A was positively correlated with the Positive Scale scores of the PANSS. Nevertheless, there were no group differences between the microstate classes. Conclusions. The results of this study indicate a negative correlation between microstate class A and global functioning in SCZ but not in BD. The association may be mediated by positive symptoms of SZ. Neural mechanisms underlying this relationship require further investigation.

目标。精神分裂症(SCZ)和双相情感障碍(BD)的脑电图微观状态研究显示出明显的差异。然而,各组患者的微观状态指标与临床症状之间的关系尚不清楚。我们的目的是研究脑电图微观状态与SCZ和BD核心特征之间的关系。本研究检查了40例SCZ患者、19例BD患者(12例BD I型和7例BD II型)和16例健康对照者的静息脑电图数据。脑电图地形图分为A、B、C、d四个典型的微状态类别。阳性和阴性综合征量表(PANSS)、青年躁狂症评定量表、汉密尔顿抑郁评定量表(HAMD)和整体功能评估量表(GAF)用于测量临床症状和整体功能。结果。SCZ患者而非BD患者的a类微状态时间比例与GAF呈显著负相关,a类微状态的发生与PANSS的Positive Scale得分呈正相关。然而,微观状态类之间没有群体差异。结论。本研究结果表明,微状态a类与SCZ整体功能呈负相关,而与BD无关。这种关联可能是由SZ阳性症状介导的。这种关系背后的神经机制需要进一步研究。
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引用次数: 3
Hard Boundary-Based Neurofeedback Training Procedure: A Modified Fixed Thresholding Method for More Accurate Guidance of Subjects Within Target Areas During Neurofeedback Training. 基于硬边界的神经反馈训练程序:一种改进的固定阈值法,在神经反馈训练中更准确地指导目标区域内的受试者。
IF 2 4区 医学 Q2 Medicine Pub Date : 2023-05-01 DOI: 10.1177/15500594221100159
Nasrin Sho'ouri

In nearly all studies within the domain of neurofeedback, a threshold has been defined for each training feature in a way that subjects' status can be evaluated during training according to the given value. In this study, a hard boundary-based neurofeedback training (HBNFT) method based on the determination of decision boundary using support vector machine (SVM) classifier was proposed in which subjects' status were clarified considering a decision boundary and they could also be encouraged once entering a target area. In this method, a scoring index (SI) was similarly defined whose value was determined in accordance with subject performance during training. The results revealed that employing a classifier and determining a decision boundary instead of using a threshold could prove more successful in accurately guiding them towards a target area and also meet no needs to choose a basis for determining a threshold. Moreover, it was likely that the proposed method could be more efficient in controlling features and preventing extreme changes compared to those using variable thresholds.

在神经反馈领域的几乎所有研究中,已经为每个训练特征定义了一个阈值,以便在训练过程中根据给定的值评估受试者的状态。本文提出了一种基于支持向量机(SVM)分类器确定决策边界的基于硬边界的神经反馈训练(HBNFT)方法,该方法根据决策边界明确被试的状态,并在进入目标区域后给予鼓励。在该方法中,同样定义了一个评分指标(SI),根据受试者在训练中的表现确定其值。结果表明,使用分类器和确定决策边界而不是使用阈值可以更成功地准确地将它们引导到目标区域,并且不需要选择确定阈值的基础。此外,与使用可变阈值的方法相比,所提出的方法可能在控制特征和防止极端变化方面更有效。
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引用次数: 2
Normalized Theta but Increased Gamma Activity after Acetylcholinesterase Inhibitor Treatment in Alzheimer's Disease: Preliminary qEEG Study. 阿尔茨海默病乙酰胆碱酯酶抑制剂治疗后Theta正常化但Gamma活动增加:初步qEEG研究
IF 2 4区 医学 Q2 Medicine Pub Date : 2023-05-01 DOI: 10.1177/15500594221120723
Ezgi Fide, Deniz Yerlikaya, Didem Öz, İbrahim Öztura, Görsev Yener

Acetylcholinesterase inhibitors (AChE-I) are the core treatment of mild to severe Alzheimer's disease (AD). However, the efficacy of AChE-I treatment on electroencephalography (EEG) and cognition remains unclear. We aimed to investigate the EEG power and coherence changes, in addition to neuropsychological performance, following a one-year treatment. Nine de-novo AD patients and demographically-matched healthy controls (HC) were included. After baseline assessments, all AD participants started cholinergic therapy. We found that baseline and follow-up gamma power analyzes were similar between groups. Yet, within the AD group after AChE-I intake, individuals with AD displayed higher gamma power compared to their baselines (P < .039). Also, baseline gamma coherence analysis showed lower values in the AD than in HC (P < .048), while these differences disappeared with increased gamma values of AD patients at the follow-up. Within the AD group after AChE-I intake, individuals with AD displayed higher theta and alpha coherence compared to their baselines (all, P < .039). These increased results within the AD group may result from a subclinical epileptiform activity. Even though AChE-I is associated with lower mortality, our results showed a significant effect on EEG power yet can increase the subclinical epileptiform activity. It is essential to be conscious of the seizure risk that treatment may cause.

乙酰胆碱酯酶抑制剂(ache - 1)是轻至重度阿尔茨海默病(AD)的核心治疗药物。然而,ache - 1治疗对脑电图(EEG)和认知的影响尚不清楚。我们的目的是调查脑电图功率和连贯性的变化,除了神经心理表现,经过一年的治疗。纳入了9名新生AD患者和人口统计学匹配的健康对照(HC)。基线评估后,所有AD参与者开始接受胆碱能治疗。我们发现基线和随访的伽马功率分析在两组之间是相似的。然而,在摄入ache - 1后的AD组中,AD患者表现出比基线更高的伽马能量(P P P)
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引用次数: 2
Stimulus Induced Rhythmic, Periodic, or Ictal Discharges (SIRPIDs) and its Association with Non-convulsive Status Epilepticus in Critically Ill Patients. 危重患者刺激诱发的节律性、周期性或突发性放电(SIRPIDs)及其与非惊厥性癫痫持续状态的关系
IF 2 4区 医学 Q2 Medicine Pub Date : 2023-05-01 DOI: 10.1177/15500594221095434
Francesco Capecchi, Andrea di Giacopo, Emanuela Keller, Ian Mothershill, Lukas L Imbach

Stimulus induced repetitive periodic or ictal discharges (SIRPIDs) are a commonly observed EEG pattern in critically ill patients. However, the epileptic significance of SIRPIDs remain unclear. We identified and reviewed 55 cases with SIRPIDs according to the ACNS criteria. SIRPIDs occurred after standardized painful stimuli during a standard 20-minute EEG. These cases were investigated regarding their relation to non-convulsive status epilepticus (NCSE) according to Salzburg Consensus Criteria and in-hospital mortality. In 37/55 patients (67.3%), SIRPIDs were associated with NCSE. In most patients (26/37 cases, 70.3%) with concurrent status epilepticus, SIRPIDs occurred after status epilepticus (on average 4.8 days later), but in 3/37 patients (8.1%) they were observed before a later status epilepticus. In four cases (4/37 cases, 10.8%), SIRPIDs appeared both before and after an episode of NCSE and in other four cases the two patterns coexisted in the same EEG. In 50% of the patients, status epilepticus was refractory, super-refractory or the patient died before its resolution. The overall mortality in the cohort was high at 58.2%. These findings corroborate the hypothesis that SIRPIDs might represent a state with increased epileptogenic potential, commonly co-occurring with NCSE. Furthermore, SIRPIDs are associated with therapy-refractory course of status epilepticus and high mortality.

刺激诱发的重复周期性放电(SIRPIDs)是危重患者常见的脑电图模式。然而,sirpid的癫痫意义尚不清楚。我们根据ACNS标准鉴定并回顾了55例sirpid病例。在标准的20分钟脑电图中,在标准化的疼痛刺激后发生sirpid。根据萨尔茨堡共识标准和住院死亡率调查这些病例与非惊厥性癫痫持续状态(NCSE)的关系。在37/55例(67.3%)患者中,sirpid与NCSE相关。在并发癫痫持续状态的大多数患者(26/37例,70.3%)中,SIRPIDs发生在癫痫持续状态后(平均4.8天后),但在3/37例患者(8.1%)中,SIRPIDs发生在较晚的癫痫持续状态之前。4例(4/37,10.8%)SIRPIDs在NCSE发作前后同时出现,另外4例在同一脑电图中同时出现。50%的患者癫痫持续状态为难治性、超难治性或患者在缓解前死亡。该队列的总死亡率高达58.2%。这些发现证实了SIRPIDs可能代表一种癫痫发生潜力增加的状态,通常与NCSE共同发生的假设。此外,sirpid与治疗难治性癫痫持续状态和高死亡率有关。
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引用次数: 0
Frequency and Types of Complications Encountered in Patients With Nonconvulsive Status Epilepticus in the Neurological ICU: Impact on Outcome. 神经内科ICU非惊厥性癫痫持续状态患者并发症的频率和类型:对预后的影响
IF 2 4区 医学 Q2 Medicine Pub Date : 2023-05-01 DOI: 10.1177/15500594211046722
Nese Dericioglu, Cansu Ayvacioglu Cagan, Okan Sokmen, Ethem Murat Arsava, Mehmet Akif Topcuoglu

Objectives. The frequency and types of complications in patients with nonconvulsive status epilepticus (NCSE) who are followed up in the intensive care unit (ICU), and the impact of these complications on outcome are not well-known. We investigated the complications and their effects on prognosis in NCSE patients. Methods. After reviewing the video-EEG monitoring (VEEGM) reports of all the consecutive patients who were followed up in our ICU between 2009 and 2019, we identified two groups of patients: 1-patients with NCSE (study group) and 2-patients who underwent VEEGM for possible NCSE but did not have ictal recordings (no-NCSE group). Electronic health records were reviewed to identify demographic and clinical data, duration of ICU care, medical and surgical complications, pharmacologic treatment, and outcome. These parameters were compared statistically between the groups. We also investigated the parameters affecting prognosis at discharge. Results. Thirty-two patients with NCSE comprised the study group. Infection developed in 84%. More than half were intubated, had tracheostomy or percutaneous endoscopic gastrostomy application. Refractory NCSE was associated with significantly more frequent complications and worse outcome. There was a higher tendency of infections in the study group (P = .059). Higher organ failure scores and prolonged stay in ICU predicted worse outcome (P < .05). Conclusion. The frequency of complications in patients with NCSE who are cared for in the ICU is considerable. Most of the complications are similar to the other patients in ICU, except for the higher frequency of infections. Increased physician awareness about modifiable parameters and timely interventions might help improve prognosis.

目标。在重症监护病房(ICU)随访的非惊厥性癫痫持续状态(NCSE)患者并发症的发生频率和类型以及这些并发症对预后的影响尚不清楚。我们探讨了NCSE患者的并发症及其对预后的影响。方法。在回顾了2009年至2019年在ICU随访的所有连续患者的视频脑电图监测(VEEGM)报告后,我们确定了两组患者:1例NCSE患者(研究组)和2例因可能的NCSE而接受VEEGM但没有心电图记录的患者(无NCSE组)。对电子健康记录进行审查,以确定人口统计和临床数据、ICU护理时间、内科和外科并发症、药物治疗和结果。这些参数在两组间进行统计学比较。我们还研究了出院时影响预后的参数。结果。32例NCSE患者组成研究组。84%发生感染。半数以上患者接受气管插管、气管造口术或经皮内镜胃造口术。难治性NCSE与更频繁的并发症和更差的预后相关。研究组感染倾向较高(P = 0.059)。器官衰竭评分越高,ICU住院时间越长,预后越差(P结论。在ICU护理的NCSE患者并发症的频率相当高。除感染发生率较高外,其余并发症与ICU患者相似。提高医生对可修改参数的认识和及时干预可能有助于改善预后。
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Clinical EEG and Neuroscience
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