Application of continuous electroencephalography monitoring in patients with severe brain injuries / 中国实用内科杂志

Continuous electroencephalography is an indispensable part of multi-mode monitoring of neurological function in severe patients as a non-invasive,bedside,continuous and real-time monitoring method.The purpose and indications for CEEG includes non-convulsive seizure and non-convulsive seizure status detection,monitoring the effects of treatment(including sedative and anti-epileptic drugs),to evaluate cerebral blood flow,grading and classification of EEG abnormalities and prognostication.Since the application of CEEG in critical patients is in its infancy,the standardization such as number of electrodes and duration,as well as the pathological and therapeutic significance of various abnormal EEG changes,still needs to be further studied.However,there is no doubt that CEEG is of great helpful for physicians to detect brain dysfunction early to carry out intervention and dynamic monitoring,as well as to make prognostication.It is always indispensable in the management of severe neurological patients and is worthy of attention.

Nonconvulsive Seizures of Traumatic Brain Injury Patients / 대한신경손상학회지

OBJECTIVE: Seizures are common consequence of traumatic brain injury and have been reported in clinical series as an incidence of 15% to 22%. Among them, nonconvulsive seizures (NCS) are often unrecognized during the early period of neurosurgical hospitalization because their clinical presentations can be misunderstood as consequent symptoms of clinical course, and the diagnosis can be confirmed only by the electroencephalographic (EEG) recording. METHODS: We retrospectively reviewed our clinical database of traumatic brain injury (TBI) patients admitted between March 2008 and September 2012. Twenty one patients with suspicious symptoms of NCS, such as decrease of consciousness, aphasia or irritability, were included. Routine wake and sleep EEG or bedside continuous EEG monitoring were done in all patients. RESULTS: Ten out of twenty-one patients showed abnormal activities on EEG. Ictal discharges were documented on four patients. Based on clinical symptoms and EEG findings, these four patients were diagnosed as NCS. Two out of four NCS patients showed EEG findings of nonconvulsive status epilepticus (NCSE). Another six patients with abnormal EEG activities were considered as 'suspicious NCS' because only interictal activities were recorded on EEG but increasing dose or adding on antiepileptics relieved their symptoms. All NCS/NCSE were successfully controlled by appropriate antiepileptic therapy. CONCLUSION: Our result showed that NCS was diagnosed in about 20% of patients with suspicious symptoms. There's a possibility that actual NCS might have happened more. Because untreated NCS/NCSE might cause worse clinical outcome, careful observation and urgent EEG recordings should be considered in a patient with suspicious NCS symptoms.