Mnemotecnias para la aplicación e interpretación del electroencefalograma de amplitud integrada en recién nacidos / Mnemonics for the use and interpretation of amplitude-integrated electroencephalography in newborn infants

La electroencefalografía (EEG) siempre ha sido considerada una materia especializada, que amerita de entrenamiento para su aplicación e interpretación; esto ha provocado que el acceso a estos estudios quedara confinado a neurólogos y neurofisiólogos. El recién nacido ingresado en la unidad de cuidados intensivos neonatales (UCIN) amerita de monitorización neurológica para establecer diagnóstico y pronóstico, por lo que se necesita una herramienta sencilla y accesible para el personal de la UCIN. Estas características han sido cubiertas por el electroencefalograma de amplitud integrada (aEEG) que, a través de patrones visuales simples de la actividad cerebral, permite el abordaje de la condición neurológica. El objetivo de este ensayo se orienta al manejo de mnemotecnias que faciliten la identificación de patrones visuales normales y patológicos en el aEEG. La nomenclatura empleada, aunque puede parecer simple, pretende crear una idea fácilmente asimilable de los conceptos básicos para la aplicación e interpretación de la neuromonitorización con aEEG.

An electroencephalography (EEG) has always been considered a specialized field, whose use and interpretation requires training. For this reason, access to these monitoring studies has been restricted to neurologists and neurophysiologists. Newborn infants admitted to the neonatal intensive care unit (NICU) require neurophysiological monitoring to establish their diagnosis and prognosis, so a simple and accessible tool is required for NICU staff. Such features have been covered by amplitude-integrated electroencephalography (aEEG), which, through simple visual patterns of brain activity, allows to approach neurological conditions. The objective of this study is to help with the management of mnemonics that facilitate the identification of normal and pathological visual patterns in an aEEG. Although simple in appearance, this nomenclature is intended to create an easy-to-understand idea of basic concepts for the use and interpretation of neurophysiological monitoring with aEEG.

Preliminary Study on Application of Combined Monitoring of Neuroelectrophysiology-Intracranial Pressure-Cerebral Perfusion Pressure in Craniotomy for Intracranial Aneurysm Clipping: An Anatomical and Clinical Study

SUMMARY: Intracranial aneurysm is a common cerebrovascular disease with high mortality. Neurosurgical clipping for the treatment of intracranial aneurysms can easily lead to serious postoperative complications. Studies have shown that intraoperative monitoring of the degree of cerebral ischemia is extremely important to ensure the safety of operation and improve the prognosis of patients. Aim of this study was to probe the application value of combined monitoring of intraoperative neurophysiological monitoring (IONM)-intracranial pressure (ICP)-cerebral perfusion pressure (CPP) in craniotomy clipping of intracranial aneurysms. From January 2020 to December 2022, 126 patients in our hospital with intracranial aneurysms who underwent neurosurgical clipping were randomly divided into two groups. One group received IONM monitoring during neurosurgical clipping (control group, n=63), and the other group received IONM-ICP-CPP monitoring during neurosurgical clipping (monitoring group, n=63). The aneurysm clipping and new neurological deficits at 1 day after operation were compared between the two groups. Glasgow coma scale (GCS) score and national institutes of health stroke scale (NIHSS) score were compared before operation, at 1 day and 3 months after operation. Glasgow outcome scale (GOS) and modified Rankin scale (mRS) were compared at 3 months after operation. All aneurysms were clipped completely. Rate of new neurological deficit at 1 day after operation in monitoring group was 3.17 % (2/63), which was markedly lower than that in control group of 11.11 % (7/30) (P0.05). Combined monitoring of IONM-ICP-CPP can monitor the cerebral blood flow of patients in real time during neurosurgical clipping, according to the monitoring results, timely intervention measures can improve the consciousness state of patients in early postoperative period and reduce the occurrence of early postoperative neurological deficits.

El aneurisma intracraneal es una enfermedad cerebrovascular común con alta mortalidad. El clipaje neuroquirúrgico para el tratamiento de aneurismas intracraneales puede provocar complicaciones posoperatorias graves. Los estudios han demostrado que la monitorización intraoperatoria del grado de isquemia cerebral es extremadamente importante para garantizar la seguridad de la operación y mejorar el pronóstico de los pacientes. El objetivo de este estudio fue probar el valor de la aplicación de la monitorización combinada de la monitorización neurofisiológica intraoperatoria (IONM), la presión intracraneal (PIC) y la presión de perfusión cerebral (CPP) en el clipaje de craneotomía de aneurismas intracraneales. Desde enero de 2020 hasta diciembre de 2022, 126 pacientes de nuestro hospital con aneurismas intracraneales que se sometieron a clipaje neuroquirúrgico se dividieron aleatoriamente en dos grupos. Un grupo recibió monitorización IONM durante el clipaje neuroquirúrgico (grupo de control, n=63) y el otro grupo recibió monitorización IONM-ICP-CPP durante el clipaje neuroquirúrgico (grupo de monitorización, n=63). Se compararon entre los dos grupos el recorte del aneurisma y los nuevos déficits neurológicos un día después de la operación. La puntuación de la escala de coma de Glasgow (GCS) y la puntuación de la escala de accidentes cerebrovasculares de los institutos nacionales de salud (NIHSS) se compararon antes de la operación, 1 día y 3 meses después de la operación. La escala de resultados de Glasgow (GOS) y la escala de Rankin modificada (mRS) se compararon 3 meses después de la operación. Todos los aneurismas fueron cortados por completo. La tasa de nuevo déficit neurológico 1 día después de la operación en el grupo de seguimiento fue del 3,17 % (2/63), que fue notablemente inferior a la del grupo de control del 11,11 % (7/30) (P 0,05). La monitorización combinada de IONM-ICP-CPP puede controlar el flujo sanguíneo cerebral de los pacientes en tiempo real durante el corte neuroquirúrgico; de acuerdo con los resultados de la monitorización, las medidas de intervención oportunas pueden mejorar el estado de conciencia de los pacientes en el período postoperatorio temprano y reducir la aparición de problemas postoperatorios tempranos y déficits neurológicos.

Multisensory Conflict Impairs Cortico-Muscular Network Connectivity and Postural Stability: Insights from Partial Directed Coherence Analysis / 神经科学通报·英文版

Sensory conflict impacts postural control, yet its effect on cortico-muscular interaction remains underexplored. We aimed to investigate sensory conflict's influence on the cortico-muscular network and postural stability. We used a rotating platform and virtual reality to present subjects with congruent and incongruent sensory input, recorded EEG (electroencephalogram) and EMG (electromyogram) data, and constructed a directed connectivity network. The results suggest that, compared to sensory congruence, during sensory conflict: (1) connectivity among the sensorimotor, visual, and posterior parietal cortex generally decreases, (2) cortical control over the muscles is weakened, (3) feedback from muscles to the cortex is strengthened, and (4) the range of body sway increases and its complexity decreases. These results underline the intricate effects of sensory conflict on cortico-muscular networks. During the sensory conflict, the brain adaptively decreases the integration of conflicting information. Without this integrated information, cortical control over muscles may be lessened, whereas the muscle feedback may be enhanced in compensation.

Detección de novedad y codificación predictiva en el sistema auditivo: Impacto clínico en disfunciones auditivas y vestibulares. Revisión de la literatura / Deviance detection and predictive coding in the auditory system: Clinical impact in auditory and vestibular dysfunctions

Una propiedad fundamental de los sistemas sensoriales es su capacidad para detectar estímulos novedosos en el entorno. El sistema nervioso posee neuronas que disminuyen su respuesta a los estímulos sonoros que se repiten a lo largo del tiempo y otras neuronas que aumentan su frecuencia de disparo ante estímulos novedosos, siendo la diferencia entre ambas respuestas conocida como adaptación-específica a estímulos. En las últimas décadas, se ha propuesto que el cerebro establece, continuamente, predicciones de los estímulos novedosos y del entorno basándose en sus experiencias previas y en modelos de representación internos, teoría denominada codificación predictiva. En esta revisión, abordaremos algunos conceptos de la adaptación-específica a estímulos y codificación predictiva, centrándonos principalmente en el sistema auditivo. Por último, propondremos una explicación teórica basada en el marco de la codificación predictiva para algunas disfunciones neuropsiquiátricas, auditivas y vestibulares.

A fundamental property of sensory systems is their ability to detect novel stimuli in the environment. The nervous system possesses neurons that decrease their response to sound stimuli that are repeated over time and other neurons that increase their firing rate to novel stimuli, the difference between the two responses being known as stimulus-specific adaptation. In recent decades, it has been proposed that the brain continuously makes predictions of novel stimuli and the environment based on its previous experiences and internal representational models, a theory called predictive coding. In this review, we will address some concepts of stimulus-specific adaptation and predictive coding, focusing mainly on the auditory system. Finally, we will propose a theoretical explanation based on the predictive coding framework for some neuropsychiatric, auditory, and vestibular dysfunctions.

A research on epilepsy source localization from scalp electroencephalograph based on patient-specific head model and multi-dipole model / 生物医学工程学杂志

Accurate source localization of the epileptogenic zone (EZ) is the primary condition of surgical removal of EZ. The traditional localization results based on three-dimensional ball model or standard head model may cause errors. This study intended to localize the EZ by using the patient-specific head model and multi-dipole algorithms using spikes during sleep. Then the current density distribution on the cortex was computed and used to construct the phase transfer entropy functional connectivity network between different brain areas to obtain the localization of EZ. The experiment result showed that our improved methods could reach the accuracy of 89.27% and the number of implanted electrodes could be reduced by (19.34 ± 7.15)%. This work can not only improve the accuracy of EZ localization, but also reduce the additional injury and potential risk caused by preoperative examination and surgical operation, and provide a more intuitive and effective reference for neurosurgeons to make surgical plans.

Automatic sleep staging based on power spectral density and random forest / 生物医学工程学杂志

The method of using deep learning technology to realize automatic sleep staging needs a lot of data support, and its computational complexity is also high. In this paper, an automatic sleep staging method based on power spectral density (PSD) and random forest is proposed. Firstly, the PSDs of six characteristic waves (K complex wave, δ wave, θ wave, α wave, spindle wave, β wave) in electroencephalogram (EEG) signals were extracted as the classification features, and then five sleep states (W, N1, N2, N3, REM) were automatically classified by random forest classifier. The whole night sleep EEG data of healthy subjects in the Sleep-EDF database were used as experimental data. The effects of using different EEG signals (Fpz-Cz single channel, Pz-Oz single channel, Fpz-Cz + Pz-Oz dual channel), different classifiers (random forest, adaptive boost, gradient boost, Gaussian naïve Bayes, decision tree, K-nearest neighbor), and different training and test set divisions (2-fold cross-validation, 5-fold cross-validation, 10-fold cross-validation, single subject) on the classification effect were compared. The experimental results showed that the effect was the best when the input was Pz-Oz single-channel EEG signal and the random forest classifier was used, no matter how the training set and test set were transformed, the classification accuracy was above 90.79%. The overall classification accuracy, macro average F1 value, and Kappa coefficient could reach 91.94%, 73.2% and 0.845 respectively at the highest, which proved that this method was effective and not susceptible to data volume, and had good stability. Compared with the existing research, our method is more accurate and simpler, and is suitable for automation.

Automatic sleep staging algorithm for stochastic depth residual networks based on transfer learning / 生物医学工程学杂志

The existing automatic sleep staging algorithms have the problems of too many model parameters and long training time, which in turn results in poor sleep staging efficiency. Using a single channel electroencephalogram (EEG) signal, this paper proposed an automatic sleep staging algorithm for stochastic depth residual networks based on transfer learning (TL-SDResNet). Firstly, a total of 30 single-channel (Fpz-Cz) EEG signals from 16 individuals were selected, and after preserving the effective sleep segments, the raw EEG signals were pre-processed using Butterworth filter and continuous wavelet transform to obtain two-dimensional images containing its time-frequency joint features as the input data for the staging model. Then, a ResNet50 pre-trained model trained on a publicly available dataset, the sleep database extension stored in European data format (Sleep-EDFx) was constructed, using a stochastic depth strategy and modifying the output layer to optimize the model structure. Finally, transfer learning was applied to the human sleep process throughout the night. The algorithm in this paper achieved a model staging accuracy of 87.95% after conducting several experiments. Experiments show that TL-SDResNet50 can accomplish fast training of a small amount of EEG data, and the overall effect is better than other staging algorithms and classical algorithms in recent years, which has certain practical value.

Analysis of neural fragility in epileptic zone based on stereoelectroencephalography / 生物医学工程学杂志

There are some limitations in the localization of epileptogenic zone commonly used by human eyes to identify abnormal discharges of intracranial electroencephalography in epilepsy. However, at present, the accuracy of the localization of epileptogenic zone by extracting intracranial electroencephalography features needs to be further improved. As a new method using dynamic network model, neural fragility has potential application value in the localization of epileptogenic zone. In this paper, the neural fragility analysis method was used to analyze the stereoelectroencephalography signals of 35 seizures in 20 patients, and then the epileptogenic zone electrodes were classified using the random forest model, and the classification results were compared with the time-frequency characteristics of six different frequency bands extracted by short-time Fourier transform. The results showed that the area under curve (AUC) of epileptic focus electrodes based on time-frequency analysis was 0.870 (delta) to 0.956 (high gamma), and its classification accuracy increased with the increase of frequency band, while the AUC by using neural fragility could reach 0.957. After fusing the neural fragility and the time-frequency characteristics of the γ and high γ band, the AUC could be further increased to 0.969, which was improved on the original basis. This paper verifies the effectiveness of neural fragility in identifying epileptogenic zone, and provides a theoretical reference for its further clinical application.

A study on the application of cross-frequency coupling characteristics of neural oscillation in the diagnosis of mild cognitive impairment / 生物医学工程学杂志

In order to fully explore the neural oscillatory coupling characteristics of patients with mild cognitive impairment (MCI), this paper analyzed and compared the strength of the coupling characteristics for 28 MCI patients and 21 normal subjects under six different-frequency combinations. The results showed that the difference in the global phase synchronization index of cross-frequency coupling under δ-θ rhythm combination was statistically significant in the MCI group compared with the normal control group ( P = 0.025, d = 0.398). To further validate this coupling feature, this paper proposed an optimized convolutional neural network model that incorporated a time-frequency data enhancement module and batch normalization layers to prevent overfitting while enhancing the robustness of the model. Based on this optimized model, with the phase locking value matrix of δ-θ rhythm combination as the single input feature, the diagnostic accuracy of MCI patients was (95.49 ± 4.15)%, sensitivity and specificity were (93.71 ± 7.21)% and (97.50 ± 5.34)%, respectively. The results showed that the characteristics of the phase locking value matrix under the combination of δ-θ rhythms can adequately reflect the cognitive status of MCI patients, which is helpful to assist the diagnosis of MCI.

Recognition of motor imagery electroencephalogram based on flicker noise spectroscopy and weighted filter bank common spatial pattern / 生物医学工程学杂志

Due to the high complexity and subject variability of motor imagery electroencephalogram, its decoding is limited by the inadequate accuracy of traditional recognition models. To resolve this problem, a recognition model for motor imagery electroencephalogram based on flicker noise spectrum (FNS) and weighted filter bank common spatial pattern ( wFBCSP) was proposed. First, the FNS method was used to analyze the motor imagery electroencephalogram. Using the second derivative moment as structure function, the ensued precursor time series were generated by using a sliding window strategy, so that hidden dynamic information of transition phase could be captured. Then, based on the characteristic of signal frequency band, the feature of the transition phase precursor time series and reaction phase series were extracted by wFBCSP, generating features representing relevant transition and reaction phase. To make the selected features adapt to subject variability and realize better generalization, algorithm of minimum redundancy maximum relevance was further used to select features. Finally, support vector machine as the classifier was used for the classification. In the motor imagery electroencephalogram recognition, the method proposed in this study yielded an average accuracy of 86.34%, which is higher than the comparison methods. Thus, our proposed method provides a new idea for decoding motor imagery electroencephalogram.

Research progress of brain-computer interface application paradigms based on rapid serial visual presentation / 生物医学工程学杂志

Rapid serial visual presentation (RSVP) is a type of psychological visual stimulation experimental paradigm that requires participants to identify target stimuli presented continuously in a stream of stimuli composed of numbers, letters, words, images, and so on at the same spatial location, allowing them to discern a large amount of information in a short period of time. The RSVP-based brain-computer interface (BCI) can not only be widely used in scenarios such as assistive interaction and information reading, but also has the advantages of stability and high efficiency, which has become one of the common techniques for human-machine intelligence fusion. In recent years, brain-controlled spellers, image recognition and mind games are the most popular fields of RSVP-BCI research. Therefore, aiming to provide reference and new ideas for RSVP-BCI related research, this paper reviewed the paradigm design and system performance optimization of RSVP-BCI in these three fields. It also looks ahead to its potential applications in cutting-edge fields such as entertainment, clinical medicine, and special military operations.

Clinical efficacy of mild therapeutic hypothermia with different rewarming time on neonatal hypoxic-ischemic encephalopathy: a prospective randomized controlled study / 中国当代儿科杂志

OBJECTIVES@#To investigate the clinical efficacy of mild therapeutic hypothermia (MTH) with different rewarming time on neonatal hypoxic-ischemic encephalopathy (HIE).@*METHODS@#A prospective study was performed on 101 neonates with HIE who were born and received MTH in Zhongshan Hospital, Xiamen University, from January 2018 to January 2022. These neonates were randomly divided into two groups: MTH1 group (n=50; rewarming for 10 hours at a rate of 0.25°C/h) and MTH2 group (n=51; rewarming for 25 hours at a rate of 0.10°C/h). The clinical features and the clinical efficacy were compared between the two groups. A binary logistic regression analysis was used to identify the factors influencing the occurrence of normal sleep-wake cycle (SWC) on amplitude-integrated electroencephalogram (aEEG) at 25 hours of rewarming.@*RESULTS@#There were no significant differences between the MTH1 and MTH2 groups in gestational age, 5-minute Apgar score, and proportion of neonates with moderate/severe HIE (P>0.05). Compared with the MTH2 group, the MTH1 group tended to have a normal arterial blood pH value at the end of rewarming, a significantly shorter duration of oxygen dependence, a significantly higher proportion of neonates with normal SWC on aEEG at 10 and 25 hours of rewarming, and a significantly higher Neonatal Behavioral Neurological Assessment score on days 5, 12, and 28 after birth (P<0.05), while there was no significant difference in the incidence rate of rewarming-related seizures between the two groups (P>0.05). There were no significant differences between the two groups in the incidence rate of neurological disability at 6 months of age and the score of Bayley Scale of Infant Development at 3 and 6 months of age (P>0.05). The binary logistic regression analysis showed that prolonged rewarming time (25 hours) was not conducive to the occurrence of normal SWC (OR=3.423, 95%CI: 1.237-9.469, P=0.018).@*CONCLUSIONS@#Rewarming for 10 hours has a better short-term clinical efficacy than rewarming for 25 hours. Prolonging rewarming time has limited clinical benefits on neonates with moderate/severe HIE and is not conducive to the occurrence of normal SWC, and therefore, it is not recommended as a routine treatment method.

Network controllability analysis of awake and asleep conditions in the brain / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

The difference between sleep and wakefulness is critical for human health. Sleep takes up one third of our lives and remains one of the most mysterious conditions; it plays an important role in memory consolidation and health restoration. Distinct neural behaviors take place under awake and asleep conditions, according to neuroimaging studies. While disordered transitions between wakefulness and sleep accompany brain disease, further investigation of their specific characteristics is required. In this study, the difference is objectively quantified by means of network controllability. We propose a new pipeline using a public intracranial stereo-electroencephalography (stereo-EEG) dataset to unravel differences in the two conditions in terms of system neuroscience. Because intracranial stereo-EEG records neural oscillations covering large-scale cerebral areas, it offers the highest temporal resolution for recording neural behaviors. After EEG preprocessing, the EEG signals are band-passed into sub-slow (0.1‍-‍1 Hz), delta (1‍-‍4 Hz), theta (4‍-‍8 Hz), alpha (8‍-‍13 Hz), beta (13‍-‍30 Hz), and gamma (30‍-‍45 Hz) band oscillations. Then, dynamic functional connectivity is extracted from time-windowed EEG neural oscillations through phase-locking value (PLV) and non-overlapping sliding time windows. Next, average and modal network controllability are implemented on these time-varying brain networks. Based on this preliminary study, it appears that significant differences exist in the dorsolateral frontal-parietal network (FPN), salience network (SN), and default-mode network (DMN). The combination of network controllability and dynamic functional networks offers new insight for characterizing distinctions between awake and asleep stages in the brain. In other words, network controllability captures the underlying brain dynamics under both awake and asleep conditions.

Levetiracetam plus Oxcarbazepine Combination Treatment Downregulates Serum Multidrug Resistance Protein 1 Levels and Upregulates Neuropeptide Y Levels in Children with Epilepsy

Abstract The aim of the present study was to investigate the usefulness of multidrug resistance protein 1 (MDR1) and neuropeptide Y (NPY) levels in predicting the efficacy of levetiracetam (LEV) plus oxcarbazepine (OXC) treatment administered to children with epilepsy and to determine their prognosis. Overall, 193 children with epilepsy admitted to the hospital were enrolled and randomly divided into two groups according to different treatment methods: group A (n = 106, treated with LEV plus OXC combination) and group B (n = 87, treated with OXC only). After treatment, compared with group B, group A exhibited a remarkably higher total effective rate and a significantly lower total adverse reaction rate. Areas under the curve for MDR1 and NPY for predicting ineffective treatment were 0.867 and 0.834, whereas those for predicting epilepsy recurrence were 0.916 and 0.829, respectively. Electroencephalography abnormalities, intracranial hemorrhage, neonatal convulsion, premature delivery, and MDR1 and NPY levels were independent risk factors for poor prognosis in children with epilepsy. Serum MDR1 and NPY levels exhibited a high predictive value for early epilepsy diagnosis, treatment efficacy assessment, and prognostication in children with epilepsy treated with LEV plus OXC combination.

Fusión de datos multimodales de neurociencias generados en estudios EEG-fMRI, un análisis temático / Fusion of Multimodal Neuroscience Data Generated in EEG-fMRI Studies, a Thematic Analysis

La actividad cerebral tiene múltiples atributos, entre ellos los eléctricos, metabólicos, hemodinámicos y hormonales. Los métodos modernos para estudiar las funciones cerebrales como el PET (Tomografía por Emisión de Positrones), fMRI (Imagen de Resonancia Magnética Funcional) y MEG (Magnetoencefalograma) son ampliamente utilizados por los científicos. Sin embargo, el EEG es una herramienta utilizada para la investigación y diagnóstico debido a su bajo costo, simplicidad de uso, movilidad y la posibilidad de monitoreo a largo tiempo de adquisición. Para detectar e interpretar las características relevantes de estas señales, se describe cada proceso por su escala temporal (EEG) y espacial (fMRI). La presente investigación se enfoca en realizar una revisión bibliográfica sobre la integración de datos multimodales EEG-fMRI que propicie valorar su importancia para el desarrollo de algoritmos de fusión y su uso en el contexto cubano. Para ello se analizaron documentos con altos índices de citas en la literatura, donde se destacan autores precursores de los temas en análisis. Los estudios multimodales EEG-fMRI generan múltiples datos temporales y espaciales con alto valor para la medicina basada en evidencia. La integración de los mismos provee un valor agregado en la búsqueda de nuevos métodos diagnósticos, aplicando minería de datos, Deep learning y algoritmos de fusión. En este trabajo se pone de relieve la existencia de baja resolución temporal de fMRI y por otro lado la baja resolución espacial de EEG, por lo que la integración de ambos estudios aumentaría la calidad de su información(AU)

Brain activity has multiple attributes, including electrical, metabolic, hemodynamic, and hormonal. Modern methods for studying brain functions such as PET (Positron Emission Tomography), fMRI (Functional Magnetic Resonance Imaging), and MEG (Magnetoencephalogram) are widely used by scientists. However, the EEG is a tool used for research and diagnosis due to its low cost, simplicity of use, mobility and the possibility of long-term monitoring of acquisition. To detect and interpret the relevant characteristics of these signals, each process is described by its temporal (EEG) and spatial (fMRI) scale. The present research focuses on conducting a bibliographic review on the integration of multimodal EEG-fMRI data that favors assessing its importance for the development of fusion algorithms and their use in the Cuban context. For this, documents with high rates of citations in the literature were analyzed, where precursor authors of the topics under analysis stand out. Multimodal EEG-fMRI studies generate multiple temporal and spatial data with high value for evidence-based medicine. Their integration provides added value in the search for new diagnostic methods, applying data mining, Deep learning and fusion algorithms. This work highlights the existence of low temporal resolution of fMRI and, on the other hand, the low spatial resolution of EEG, so the integration of both studies would increase the quality of their information(AU)

Utilidad del monitoreo continuo del electroencefalograma en el paciente crítico / Utility of continuous electroencephalogram monitoring in the critical patients

Introducción: El monitoreo continuo del Electroencefalograma, es la recogida simultánea de la actividad cerebral y la conducta clínica por un período de horas a días. Por el alto costo de la técnica aún no está muy difundida. Objetivos: Evaluar la utilidad del monitoreo electroencefalográfico continuo en el paciente crítico. Métodos: Se realizó un estudio descriptivo, retrospectivo y longitudinal en 118 sujetos mayores de 19 años ingresados en las unidades de terapia del Hospital Clínico Quirúrgico Hermanos Ameijeiras; entre noviembre 2016 a octubre 2018 con indicación de un Electroencefalograma continuo. Se consideraron variables clínicas y electroencefalográficas: escala de Glasgow, ocurrencia de crisis, diagnóstico, estado al egreso, anormalidad del Electroencefalograma, descargas epileptiformes, sospecha de estatus epiléptico no convulsivo por electroencefalograma entre otras. Los datos se procesaron con test de Chi cuadrado, test de Mc Nemar y test t de student, se empleó un nivel de significación de p≤0.05. Resultados: 60 de los pacientes pertenecían al sexo femenino, la mediana de las edades fue 67,5 años. La escala de Glasgow mostró asociación significativa con el grado de anormalidad del electroencefalograma (p=0,001), es la arreactividad y la discontinuidad de la actividad de base predictores de pobre pronóstico. Se observaron descargas epileptiformes periódicas en 100 pacientes. Se definió estatus epiléptico no convulsivo en 56 sujetos (37,28 por ciento) y en 81 sujetos (68,64 por ciento) el resultado del electroencefalograma motivó una conducta médica. Conclusiones: El monitoreo continuo del electroencefalograma es útil en el diagnóstico y manejo del paciente con episodios no convulsivos, permite formular un pronóstico neurológico y orientó la conducta médica(AU)

Introduction: The continuous monitoring of the electroencephalogram is the simultaneous collection of brain activity and clinical behavior for a period of hours to days. Due to the high cost of the technique, it is not yet widely used. Objectives: To evaluate the usefulness of continuous electroencephalographic monitoring in critically ill patients. Methods: A descriptive, retrospective and longitudinal study was carried out in 118 subjects over 19 years of age admitted to the therapy units at Hermanos Ameijeiras Surgical Clinical Hospital; from November 2016 to October 2018. They were indicated a continuous electroencephalogram. Clinical and electroencephalographic variables were considered, such as Glasgow scale, seizure occurrence, diagnosis, discharge status, electroencephalogram abnormality, epileptiform discharges, suspicion of nonconvulsive status epilepticus by electroencephalogram, among others. The data was processed with the Chi square test, the Mc Nemar test and the student's t test, using significance level of p≤0.05. Results: Sixty patients were female, the median age was 67.5 years. The Glasgow scale showed significant association with the degree of electroencephalogram abnormality (p=0.001). A reactivity and discontinuity of baseline activity are predictors of poor prognosis. Periodic epileptiform discharges were observed in 100 patients. Non-convulsive status epilepticus was defined in 56 subjects (37.28 percent) and in 81 subjects (68.64 percent) the result of the electroencephalogram motivated a medical procedure. Conclusions: The continuous monitoring of the electroencephalogram is useful in the diagnosis and management of patients with non-convulsive episodes, it allows formulating a neurological prognosis and guided medical conduct(AU)

EEG education in Brazil: a national survey of adult neurology residents / Educação em EEG no Brasil: uma pesquisa nacional com residentes de neurologia de adultos

ABSTRACT Background: In light of the established challenges of resident EEG education worldwide, we sought to better understand the current state of neurology resident EEG education in Brazil. Objective: To define Brazilian EEG practices including in-residency requirements for EEG training and competency. Methods: We assessed the perspectives of adult residents (PGY1-3) on EEG education and their level of confidence interpreting EEG with a 24-question online survey. Results: We analyzed 102 responses from 52 Brazilian neurology residency programs distributed in 14 states. There were 18 PGY1s, 45 PGY2s, and 39 PGY3s. Ninety-six percent of participants reported that learning how to read EEG during residency was very or extremely important. The most commonly reported barriers to EEG education were insufficient EEG exposure (70%) and ineffective didactics (46%). Residents believed that standard EEG lectures were the most efficient EEG teaching method followed by interpreting EEG with attendings' supervision. Roughly half of residents (45%) reported not being able to read EEG even with supervision, and approximately 70% of all participants did not feel confident writing an EEG report independently. Conclusion: Despite the well-established residency EEG education requirements recommended by the Brazilian Academy of Neurology (ABN), there seems to be a significant lack of comfort interpreting EEG among Brazilian adult neurology residents. We encourage Brazilian neurology residency leadership to re-evaluate the current EEG education system in order to ensure that residency programs are following EEG education requirements and to assess whether EEG benchmarks require modifications.

RESUMO Antecedentes: Diante dos desafios da educação em EEG estabelecidos em todo o mundo, buscamos compreender melhor o estado atual da educação em EEG durante a residência de neurologia no Brasil. Objetivo: Investigar práticas de EEG no Brasil, incluindo requisitos para treinamento e competência durante a residência de neurologia. Métodos: Avaliamos as perspectivas dos residentes (R1-3) de neurologia (adulto) sobre educação em EEG e nível de confiança ao interpretá-lo através de questionário online de 24 perguntas. Resultados: Foram analisadas 102 respostas de 52 programas de residência distribuídos em 14 estados. Dezoito R1s, 45 R2s e 39 R3s responderam à pesquisa. Noventa e seis por cento dos participantes relataram que aprender a ler EEG durante a residência é muito ou extremamente importante. As barreiras mais relatadas para educação em EEG foram exposição insuficiente ao EEG (70%) e didática ineficaz (46%). Os participantes apontaram aulas como método de ensino mais eficaz, seguido pela interpretação do EEG supervisionada pelos chefes. Aproximadamente metade dos residentes (45%) relatou não ser capaz de ler EEG mesmo com supervisão e cerca de 70% não se sente confiante para escrever um laudo de EEG de forma independente. Conclusões: Apesar dos requisitos estabelecidos pela Academia Brasileira de Neurologia (ABN) sobre ensino de EEG durante a residência, há significativa falta de confiança na sua interpretação pelos residentes de neurologia (adulto). Incentivamos as lideranças a reavaliar o sistema de educação para garantir que os programas de residência sigam requisitos de educação em EEG e se os benchmarks de EEG requerem modificações.

Motor imagery electroencephalogram classification based on sparse spatiotemporal decomposition and channel attention / 生物医学工程学杂志

Motor imagery electroencephalogram (EEG) signals are non-stationary time series with a low signal-to-noise ratio. Therefore, the single-channel EEG analysis method is difficult to effectively describe the interaction characteristics between multi-channel signals. This paper proposed a deep learning network model based on the multi-channel attention mechanism. First, we performed time-frequency sparse decomposition on the pre-processed data, which enhanced the difference of time-frequency characteristics of EEG signals. Then we used the attention module to map the data in time and space so that the model could make full use of the data characteristics of different channels of EEG signals. Finally, the improved time-convolution network (TCN) was used for feature fusion and classification. The BCI competition IV-2a data set was used to verify the proposed algorithm. The experimental results showed that the proposed algorithm could effectively improve the classification accuracy of motor imagination EEG signals, which achieved an average accuracy of 83.03% for 9 subjects. Compared with the existing methods, the classification accuracy of EEG signals was improved. With the enhanced difference features between different motor imagery EEG data, the proposed method is important for the study of improving classifier performance.

Research on electroencephalogram power spectral density of stroke patients under transcranial direct current stimulation / 生物医学工程学杂志

Transcranial direct current stimulation (tDCS) has become a new method of post-stroke rehabilitation treatment and is gradually accepted by people. However, the neurophysiological mechanism of tDCS in the treatment of stroke still needs further study. In this study, we recruited 30 stroke patients with damage to the left side of the brain and randomly divided them into a real tDCS group (15 cases) and a sham tDCS group (15 cases). The resting EEG signals of the two groups of subjects before and after stimulation were collected, then the difference of power spectral density was analyzed and compared in the band of delta, theta, alpha and beta, and the delta/alpha power ratio (DAR) was calculated. The results showed that after real tDCS, delta band energy decreased significantly in the left temporal lobes, and the difference was statistically significant ( P < 0.05); alpha band energy enhanced significantly in the occipital lobes, and the difference was statistically significant ( P < 0.05); the difference of theta and beta band energy was not statistically significant in the whole brain region ( P > 0.05). Furthermore, the difference of delta, theta, alpha and beta band energy was not statistically significant after sham tDCS ( P > 0.05). On the other hand, the DAR value of stroke patients decreased significantly after real tDCS, and the difference was statistically significant ( P < 0.05), and there was no significant difference in sham tDCS ( P > 0.05). This study reveals to a certain extent the neurophysiological mechanism of tDCS in the treatment of stroke.

Parameter transfer learning based on shallow visual geometry group network and its application in motor imagery classification / 生物医学工程学杂志

Transfer learning is provided with potential research value and application prospect in motor imagery electroencephalography (MI-EEG)-based brain-computer interface (BCI) rehabilitation system, and the source domain classification model and transfer strategy are the two important aspects that directly affect the performance and transfer efficiency of the target domain model. Therefore, we propose a parameter transfer learning method based on shallow visual geometry group network (PTL-sVGG). First, Pearson correlation coefficient is used to screen the subjects of the source domain, and the short-time Fourier transform is performed on the MI-EEG data of each selected subject to acquire the time-frequency spectrogram images (TFSI). Then, the architecture of VGG-16 is simplified and the block design is carried out, and the modified sVGG model is pre-trained with TFSI of source domain. Furthermore, a block-based frozen-fine-tuning transfer strategy is designed to quickly find and freeze the block with the greatest contribution to sVGG model, and the remaining blocks are fine-tuned by using TFSI of target subjects to obtain the target domain classification model. Extensive experiments are conducted based on public MI-EEG datasets, the average recognition rate and Kappa value of PTL-sVGG are 94.9% and 0.898, respectively. The results show that the subjects' optimization is beneficial to improve the model performance in source domain, and the block-based transfer strategy can enhance the transfer efficiency, realizing the rapid and effective transfer of model parameters across subjects on the datasets with different number of channels. It is beneficial to reduce the calibration time of BCI system, which promote the application of BCI technology in rehabilitation engineering.