Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society
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J Clin Neurophysiol · Apr 2013
ReviewPediatric ICU EEG monitoring: current resources and practice in the United States and Canada.
To describe current continuous EEG monitoring (cEEG) utilization in critically ill children. ⋯ Among the surveyed institutions, which included primarily large academic centers, cEEG use in pediatric intensive care units is increasing and is often considered indicated for children with altered mental status at risk for nonconvulsive seizures. However, there remains substantial variability in cEEG access and utilization among institutions.
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J Clin Neurophysiol · Apr 2013
ReviewUtility of continuous EEG in children with acute traumatic brain injury.
Traumatic brain injury is a leading cause of childhood morbidity and mortality. The use of continuous EEG monitoring in the pediatric intensive care unit setting to aid in the management of acute traumatic brain injury is becoming more common, although practice does vary between institutions. This variability is a product of the relative paucity of data, particularly as it applies to prospective studies, in evaluating the use of continuous EEG after traumatic brain injury in the pediatric population. This review will summarize the current literature involving the utility of continuous EEG monitoring in children with acute traumatic brain injury, with focus on specific indications, impact on management, and prognostic value.
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Both remote monitoring and nearby/available care models depend on waveform telemetry (a limited form of telemedicine) during intraoperative neurophysiological monitoring (IONM). These dominant models neither mandate preoperative patient contact nor assume co-practitioner collegiality. This review and commentary argues in favor of a routine, normative relationship between the patient and the IONM physician/professional (IONM-P). ⋯ This "upgrade" also improves the likelihood that correct context-driven decisions will be made by the co-practitioners (IONM-P, proceduralist, and anesthesiologist) during complex multimodality monitoring. Most current models of IONM can be accommodated by readily available telemedicine-mediated videoconferencing. Several lines of argument are used to support this "patient-centered care model" of IONM.
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J Clin Neurophysiol · Feb 2013
Noninvasive predictors of subdural grid seizure localization in children with nonlesional focal epilepsy.
Subdural grid evaluation (SDE) in refractory focal epilepsy aims to precisely define the ictal onset zone and map eloquent cortex. In a small but significant proportion of children, SDE shows multifocal or diffuse, rather than focal, seizure onset. Resective epilepsy surgery is denied, or is unsuccessful, in the majority of such patients. The authors investigated whether the noninvasive data could be abstracted to predict subsequent SDE electrographic outcome (focal vs. multifocal/diffuse ictal onset). ⋯ (1) Diffuse or multifocal ictal onsets on SDE are almost three times as likely in nonlesional patients as in those with a single definite MRI brain lesion. (ii) The noninvasive data of children with nonlesional brain MRI may be summarized by a score that rewards localizing information and intermodality concordance: low-scoring patients are more likely to exhibit diffuse or multifocal ictal onset on subsequent SDE. (iii) Bayesian likelihood ratios predictive of ictal focality on SDE are highly favorable for concordant scalp interictal-ictal EEG combinations. (iv) Decision-theoretic methods of this type may find use in the selection of nonlesional pediatric presurgical candidates offered SDE.
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J Clin Neurophysiol · Feb 2013
Facilitation of corticospinal connections in able-bodied people and people with central nervous system disorders using eight interventions.
Voluntary contractions (VOL), functional electrical stimulation (FES), and transcranial magnetic stimulation (TMS) can facilitate corticospinal connections. ⋯ (1) Short-term application of FES, TMS, and VOL can facilitate corticospinal pathways, particularly when methods are combined. (2) The effects may depend on the total activation of neural pathways, which is reduced in central nervous system disorders.