Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society
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J Clin Neurophysiol · Jun 2014
Integration of EEG lead placement templates into traditional technologist-based staffing models reduces costs in continuous video-EEG monitoring service.
The purpose of this study was to determine the relative cost reductions within different staffing models for continuous video-electroencephalography (cvEEG) service by introducing a template system for 10/20 lead application. ⋯ Any implementation of templates into a technologist-based cvEEG service line results in cost savings, with the most significant annual savings coming from using the templates for all studies, but the most practical implementation approach with the second highest cost reduction being the template used in the ICU. The lowered costs determined in this work suggest that a template-based cvEEG service could be supported at smaller centers with significantly reduced costs and could allow for broader use of cvEEG patient monitoring.
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J Clin Neurophysiol · Jun 2014
Effect of age and gender on the number of motor units in healthy subjects estimated by the multipoint incremental MUNE method.
Motor unit number estimation (MUNE) is a tool for estimating the number of motor units. The aim was to evaluate the multipoint incremental MUNE method in a healthy population, to analyze whether aging, gender, and the dominant hand side influence the motor unit number, and to assess reproducibility of MUNE with the Shefner modification. ⋯ Multipoint incremental MUNE method with the Shefner modification is a noninvasive, easy to perform method with high reproducibility. The loss of motor neurons because of aging could be confirmed by our MUNE study and seems to be more pronounced in females.
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J Clin Neurophysiol · Apr 2014
ReviewComparative effectiveness analyses of intraoperative neurophysiological monitoring in spinal surgery.
Intraoperative neurophysiological monitoring for surgeries of the spine has been performed in clinical practice for several decades, but recent alterations in reimbursement schemes by third party payers have raised issues of the value of these procedures. Decision modeling using comparative effectiveness techniques holds the promise of evidence-based assessment of both cost and meaningful outcomes. In this article, we review the elements of comparative effectiveness analyses followed by a critical appraisal of the small but growing body of cost-effectiveness literature for intraoperative neurophysiological monitoring in spine.
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J Clin Neurophysiol · Feb 2014
Median nerve somatosensory evoked potential monitoring during carotid endarterectomy: does reference choice matter?
Median nerve somatosensory evoked potential monitoring is commonly used during carotid endarterectomy to permit selective shunting in only those patients who are determined to have inadequate collateral flow after carotid cross-clamping. The N20 component is recorded from the CPc (contralateral centroparietal) electrode; either CPi (ipsilateral centroparietal) or Fpz (forehead) can be used as the reference. ⋯ Although, as expected, the baseline N20 component was significantly larger when recorded with the CPc-Fpz derivation than with the CPc-CPi derivation (3.1 vs. 2.4 μV in the hemisphere ipsilateral to the clamped carotid, P < 0.001), there was no significant difference in the postclamp amplitude decline between the 2 derivations (8.7% vs. 8.6%, P = 0.82). It is concluded that CPc-Fpz is an acceptable derivation for recording postclamp hemispheric somatosensory evoked potential changes during carotid endarterectomy and may be advantageous because it provides a larger amplitude somatosensory evoked potential than the CPc-CPi derivation.
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Intraoperative neurophysiologic monitoring endeavors to preserve the integrity of the nervous system at a time of potential risk. The examination of language function in the operative setting is a unique task that requires a detailed and systematic approach to be carried out efficiently and reliably in this dynamic environment. ⋯ This technique requires a coordinated effort to testing, which is reliant on preoperative assessment and structured approach to functional cortical mapping by the surgical, anesthetic, and neurophysiology teams. Despite the intricate nature of this modality of testing, the accurate identification of language areas facilitates neurosurgeries for tumor and focal epilepsy syndromes in the dominant cerebral hemisphere, which depend on maximal margins of resection for best outcomes.