Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology
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Carotid endarterectomy is a common procedure as a secondary prevention of stroke, and one of the early controversies in carotid surgery is centered around whether a shunt should be used during this procedure. Although various EEG parameters have been proposed to determine if the brain is at risk during carotid artery clamping, the common procedure is still the visual assessment of the EEG. We propose a brain symmetry index (BSI), that has been implemented as an on-line quantitative EEG parameter, as an additional criterion for shunt need in carotid endarterectomy. ⋯ The BSI may assist in the visual EEG analysis during carotid endarterectomy and provides a quantitative measure for electroencephalographic asymmetry due to cerebral hypo-perfusion. In patients with a change in the BSI (DeltaBSI) smaller than 0.03 during test clamping, visual EEG analysis showed no changes, whereas if visual EEG analysis did warrant shunting, it was found that DeltaBSI>or=0.06.
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Case Reports
Ictal heart rate increase precedes EEG discharge in drug-resistant mesial temporal lobe seizures.
Heart rate (HR) changes, mainly tachycardia, are often observed during seizures originating from the temporal lobe. The aim of this study was to analyze the role of ictal HR changes in localizing both mesial and lateral temporal lobe epilepsy (TLE) in a group of 68 patients. The influence of the gender and the side of epilepsy on HR modulation was also evaluated. ⋯ Our findings show that ictal HR increase, preceding the onset of the EEG discharge, is associated with ictal EEG seizure pattern defining temporal lobe seizures originating from the mesial temporal lobe structures; this association suggests that the HR changes may be coupled to the functional impairment of neural circuits involved in sympathetic cardiovascular regulation, in the mesial temporal lobe structures. Further studies investigating the relationship between intracranial EEG monitoring and ECG recording are worthwhile, to confirm our results and to give further indications on the pathogenesis of ictal HR abnormalities.
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This study investigated a strategy to elicit reversible facilitation of the soleus monosynaptic H-reflex in humans using a modified tetanic stimulation technique. ⋯ This technique may be used in future studies to investigate whether the induced increased H-reflex excitability influences locomotion.
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Electroencephalographic (EEG) peak alpha frequency (PAF) (measured in Hz) has been correlated to cognitive performance between healthy and clinical individuals, and among healthy individuals. PAF also varies within individuals across developmental stages, among different cognitive tasks, and among physiological states induced by administration of various substances. The present study suggests that, among other things, PAF reflects a trait or state of cognitive preparedness. ⋯ PAF was shown to detect both trait and state differences in cognitive preparedness, as well as to be affected by cognitive tasks. Traits are better reflected during post-task rest, whereas states are better reflected during initial resting baseline recordings.
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This study sought to determine whether certain aspects of after-discharges (ADs) obtained during cortical functional mapping provide better correlations between stimulus site and that of spontaneous seizures. Secondly, we wished to determine the percentage of stimulations evoking ADs and, of these, the percentage which clearly involves more than one electrode position, potentially inaccurately localizing cortical function. Thirdly, we wished to quantify the incidences of the several AD morphologies described by Jasper [in: Epilepsy and the functional anatomy of the human brain, 1954, p. 183; p. 692] and to assess whether certain morphologies had a greater tendency to evolve in frequency or morphology. ⋯ These data illustrate the need for scrutiny of the post-stimulus electrocorticogram for ADs and particularly those involving extra stimulus sites. Whether varying the stimulus parameters prospectively will disclose a better seizure localizing value for ADs remains to be determined.