EEG guidelines in the diagnosis of brain death.

In France, for the determination and diagnostic validation of brain death the law requires either two EEG recordings separated by a 4-hour observation period, both showing electrocerebral inactivity; or cerebral angiography examination. Since EEG is available in most hospitals and clinics, it is often used in this indication, at the patient's bedside, especially in the context of organ donation. However, very precise methodology must be followed. The last French guidelines date back to 1989, before the development of digital EEG recording. We present the new guidelines from the Société de Neurophysiologie Clinique de Langue Française. Electrocerebral inactivity may be confirmed when a 30-minute good quality EEG recording shows complete electrocerebral silence, defined as no cerebral activity greater than 2 uV, having first ruled out the possible influence of sedative drugs, metabolic disorders or hypothermia. In the presence of sedative drugs, CT brain angiography will be the gold standard test for this diagnosis. In the newborn, the utmost caution is indicated since electrocerebral inactivity can be observed in the absence of cerebral death. In the infant, the criterion for the observation period to be respected between both EEG recordings needs to be more clearly refined.

[French guidelines on electroencephalogram]. / Recommandations françaises sur l'électroencéphalogramme.

Electroencephalography allows the functional analysis of electrical brain cortical activity and is the gold standard for analyzing electrophysiological processes involved in epilepsy but also in several other dysfunctions of the central nervous system. Morphological imaging yields complementary data, yet it cannot replace the essential functional analysis tool that is EEG. Furthermore, EEG has the great advantage of being non-invasive, easy to perform and allows control tests when follow-up is necessary, even at the patient's bedside. Faced with the advances in knowledge, techniques and indications, the Société de Neurophysiologie Clinique de Langue Française (SNCLF) and the Ligue Française Contre l'Épilepsie (LFCE) found it necessary to provide an update on EEG recommendations. This article will review the methodology applied to this work, refine the various topics detailed in the following chapters. It will go over the summary of recommendations for each of these chapters and underline proposals for writing an EEG report. Some questions could not be answered by the review of the literature; in those cases, an expert advice was given by the working and reading groups in addition to the guidelines.

[Role of EEG in the diagnosis of brain death]. / Place de l'EEG dans le diagnostic de mort encéphalique.

Brain death diagnosis is based upon several clinical and paraclinical criteria that have been legally defined. There is a medico-legal protocol when brain death diagnosis is made in order to allow organ removal for a possible transplantation. In France, EEG or cerebral arteriography must legally be used to confirm a clinical brain death suspicion. There is a specific procedure to perform an EEG to confirm the diagnosis of brain death. However all the criteria have been made using conventional paper EEG, while numerized is now used. The comparison of EEG recording using both analogical and numerised acquisition allow us to report several recommendations to use EEG for brain death diagnosis.

Brief and sustained movements: differences in event-related (de)synchronization (ERD/ERS) patterns.

OBJECTIVE: (1) To determine if there are changes in event-related desynchronization/event-related synchronization (ERD/ERS) patterns when the movement is sustained? (2) To determine, from a technical point of view for ERD calculation, if it is possible to take the reference period during muscular activation? METHODS: Eight healthy subjects performed two series of brief and sustained self-paced extensions with their dominant wrist. The end of the sustained movement was externally triggered by the examinator. ERD/ERS was calculated in mu and beta bands from 13 source derivations covering motor areas, computed from 29 scalp electrodes. Movement onset and offset were determined by electromyographic activity (EMG) of wrist extensors. RESULTS: When the movement was sustained, power in the mu and beta bands returned to baseline values within 4-5 s. Movement duration had little effect, if at all, on both pre and post-movement periods. Compared to brief movement, after the onset of the prolonged movement, mu ERD just returned to baseline, without synchronization. In contrast, beta ERS was still present though earlier and much lower. CONCLUSIONS: The reference period for ERD calculation may be taken during muscular activation if its duration is long enough. Beta synchronization may occur despite a non-deactivated motor cortex, suggesting a contribution from afferent somesthetic inputs.