Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society
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J Clin Neurophysiol · Apr 2015
Baseline EEG pattern on continuous ICU EEG monitoring and incidence of seizures.
To identify the probability of detecting nonconvulsive seizures based on the initial pattern seen in the first 30 minutes of continuous EEG (cEEG) monitoring. ⋯ Patients with only generalized slowing seen on the baseline EEG recording are unlikely to develop seizures on subsequent cEEG monitoring. Depending on the clinical circumstance, the standard duration of cEEG recording (24-48 hours) may be unnecessary in patients with generalized slowing as their only cEEG abnormality.
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J Clin Neurophysiol · Feb 2015
Randomized Controlled TrialInhibitory transcranial direct current stimulation enhances weak beta event-related synchronization after foot motor imagery in patients with lower limb amputation.
Sensorimotor rhythm patterns in patients with lower limb amputations might be altered because of reorganization of the sensorimotor cortices. The authors evaluated the sensorimotor rhythm of motor imagery (MI) in healthy subjects and patients with lower limb amputations. In addition, the authors investigated whether transcranial direct current stimulation (tDCS) could modulate sensorimotor rhythm control. ⋯ This is the first study to demonstrate that cathodal tDCS can enhance a weak beta ERS of foot MI in patients with lower limb amputations. These findings might contribute in improving the effectiveness of sensorimotor rhythm-based brain computer interface for gait restoration after lower limb amputation.
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J Clin Neurophysiol · Feb 2015
Randomized Controlled TrialSleep in the neurological intensive care unit: feasibility of quantifying sleep after melatonin supplementation with environmental light and noise reduction.
Sleep deprivation may be particularly detrimental to intensive care unit (ICU) patients. Polysomnography has demonstrated abnormal sleep in medical and surgical ICU populations. Both environmental factors and circadian disruption have been implicated. We hypothesized that patients in a neurologic ICU would demonstrate similar sleep disturbances and that a combination of sleep-promoting interventions would increase sleep time. ⋯ Although sleep-promoting interventions were feasible, sleep quantification based on currently accepted criteria limited the ability to score sleep. Similar to other ICUs, sleep in the neurologic ICU is abnormal; patients with unscorable sleep-like states have greater injury severity. This study was limited by strict enrollment criteria. A reliable method to quantify sleep and sleep-like states in the ICU is needed.
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J Clin Neurophysiol · Feb 2015
ReviewRespiratory pathophysiology with seizures and implications for sudden unexpected death in epilepsy.
There is increasing evidence that periictal respiratory disturbances are an important contributor to the pathophysiological changes leading to sudden unexpected death in epilepsy (SUDEP). In patients with SUDEP occurring in epilepsy monitoring units, respiratory disturbances occurred early in the postictal period and frequently preceded terminal bradycardia and asystole. Periictal hypoxemia and hypercapnia are observed in about one-third of patients undergoing video-EEG telemetry. ⋯ Serotonergic neurons modulate the excitability of the neuronal network generating the respiratory rhythm. Ictal and periictal impairment of serotonergic and glutaminergic neurons involved in the arousal system may also predispose to SUDEP by impeding the patient's ability to reposition the head and facilitate ventilation after a seizure. Periictal functional impairment of serotonergic neurons seems to be important in the pathophysiology of SUDEP and a potential target for pharmacotherapy aimed at SUDEP risk reduction.
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J Clin Neurophysiol · Dec 2014
Comparative StudyTrain-of-four test in intraoperative neurophysiologic monitoring: differences between hand and foot train-of-four.
Comparison of T1-T4 decrement between upper and lower extremity muscles can indicate differences between recovery time from neuromuscular blockade, which may have repercussions for neurophysiologic intraoperative monitoring. We investigated decrement between T1 and T4 hand and foot muscle responses on quantitative train-of-four (TOF) test. ⋯ The observed difference between recovery of hand and foot muscles suggests that quantitative TOF test should be performed on extremities for which accurate data about the level of neuromuscular blockade is sought. During lumbar spine surgery monitoring, in addition to hand TOF, foot TOF should be included.