Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 47
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
2.
Crit Care Med ; 2019 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-31876526

RESUMO

OBJECTIVES: To evaluate the performance of commercially available seizure detection algorithms in critically ill children. DESIGN: Diagnostic accuracy comparison between commercially available seizure detection algorithms referenced to electroencephalography experts using quantitative electroencephalography trends. SETTING: Multispecialty quaternary children's hospital in Canada. SUBJECTS: Critically ill children undergoing electroencephalography monitoring. INTERVENTIONS: Continuous raw electroencephalography recordings (n = 19) were analyzed by a neurophysiologist to identify seizures. Those recordings were then converted to quantitative electroencephalography displays (amplitude-integrated electroencephalography and color density spectral array) and evaluated by six independent electroencephalography experts to determine the sensitivity and specificity of the amplitude-integrated electroencephalography and color density spectral array displays for seizure identification in comparison to expert interpretation of raw electroencephalography data. Those evaluations were then compared with four commercial seizure detection algorithms: ICTA-S (Stellate Harmonie Version 7; Natus Medical, San Carlos, CA), NB (Stellate Harmonie Version 7; Natus Medical), Persyst 11 (Persyst Development, Prescott, AZ), and Persyst 13 (Persyst Development) to determine sensitivity and specificity in comparison to amplitude-integrated electroencephalography and color density spectral array. MEASUREMENTS AND MAIN RESULTS: Of the 379 seizures identified on raw electroencephalography, ICTA-S detected 36.9%, NB detected 92.3%, Persyst 11 detected 75.9%, and Persyst 13 detected 74.4%, whereas electroencephalography experts identified 76.5% of seizures using color density spectral array and 73.7% using amplitude-integrated electroencephalography. Daily false-positive rates averaged across all recordings were 4.7 with ICTA-S, 126.3 with NB, 5.1 with Persyst 11, 15.5 with Persyst 13, 1.7 with color density spectral array, and 1.5 with amplitude-integrated electroencephalography. Both Persyst 11 and Persyst 13 had sensitivity comparable to that of electroencephalography experts using amplitude-integrated electroencephalography and color density spectral array. Although Persyst 13 displayed the highest sensitivity for seizure count and seizure burden detected, Persyst 11 exhibited the best trade-off between sensitivity and false-positive rate among all seizure detection algorithms. CONCLUSIONS: Some commercially available seizure detection algorithms demonstrate performance for seizure detection that is comparable to that of electroencephalography experts using quantitative electroencephalography displays. These algorithms may have utility as early warning systems that prompt review of quantitative electroencephalography or raw electroencephalography tracings, potentially leading to more timely seizure identification in critically ill patients.

3.
Epilepsy Behav ; 101(Pt B): 106409, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31420288

RESUMO

Pediatric status epilepticus carries a substantial risk for morbidity and mortality, but the relationship between seizure burden, treatment, and outcome remains incompletely understood. This review summarizes the evidence linking seizure burden and outcomes among critically ill children in the intensive care unit (ICU), a population in whom accurate quantification of seizure burden is possible using continuous electroencephalographic monitoring. Several high-quality observational studies among critically ill children have reported an association between higher seizure burden and worse outcome, even after adjusting for potential confounders such as age, etiology, and illness severity. Although these studies support the hypothesis that seizures contribute to brain injury and worsen outcome, a causal link between seizures and outcome remains to be proven. The relationship between seizures and outcome is likely complex, and dependent on factors such as etiology, preexisting neurological disability, medication exposure, and possibly individual genetic factors. Studies attempting to define this complex relationship will need to measure and account for these factors in their analyses. This article is part of the Special Issue "Proceedings of the 7th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures".

4.
J Pediatr ; 209: 23-32, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30982528

RESUMO

OBJECTIVES: To investigate how glucose abnormalities correlate with brain function on amplitude-integrated electroencephalography (aEEG) in infants with neonatal encephalopathy. STUDY DESIGN: Neonates born at full term with encephalopathy were enrolled within 6 hours of birth in a prospective cohort study at a pediatric academic referral hospital. Continuous interstitial glucose monitors and aEEG were placed soon after birth and continued for 3 days. Episodes of hypoglycemia (≤50 mg/dL; ≤2.8 mmol/L) and hyperglycemia (>144 mg/dL; >8.0 mmol/L) were identified. aEEG was classified in 6-hour epochs for 3 domains (background, sleep-wake cycling, electrographic seizures). Generalized estimating equations assessed the relationship of hypo- or hyperglycemia with aEEG findings, adjusting for clinical markers of hypoxia-ischemia (Apgar scores, umbilical artery pH, and base deficit). RESULTS: Forty-five infants (gestational age 39.5 ± 1.4 weeks) were included (24 males). During aEEG monitoring, 16 episodes of hypoglycemia were detected (9 infants, median duration 77.5, maximum 220 minutes) and 18 episodes of hyperglycemia (13 infants, median duration 237.5, maximum 3125 minutes). Epochs of hypoglycemia were not associated with aEEG changes. Compared with epochs of normoglycemia, epochs of hyperglycemia were associated with worse aEEG background scores (B 1.120, 95% CI 0.501-1.738, P < .001), less sleep-wake cycling (B 0.587, 95% CI 0.417-0.757, P < .001) and more electrographic seizures (B 0.433, 95% CI 0.185-0.681, P = .001), after adjusting for hypoxia-ischemia severity. CONCLUSIONS: In neonates with encephalopathy, epochs of hyperglycemia were temporally associated with worse global brain function and seizures, even after we adjusted for hypoxia-ischemia severity. Whether hyperglycemia causes neuronal injury or is simply a marker of severe brain injury requires further study.

5.
Seizure ; 68: 38-45, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30528098

RESUMO

PURPOSE: To summarize the use of continuous electroencephalographic monitoring (cEEG) in the diagnosis and management of pediatric convulsive status epilepticus (CSE) and subsequent non-convulsive seizures (NCS) with a focus on available guidelines and infrastructure. In addition, we provide an overview of quantitative EEG (QEEG) for the identification of NCS in critically ill children. METHODS: We performed a review of the medical literature on the use of cEEG and QEEG in pediatric CSE. This included published guideline, consensus statements, and literature focused on the use of cEEG and QEEG to detect NCS. RESULTS: cEEG monitoring is recommended for prompt recognition of ongoing seizures that may be subtle, masked by pharmacologic paralysis, and or converted from convulsive seizures to NCS after administration of anti-seizure medications. Evidence indicating that high seizure burden is associated with worse outcome has motivated prompt recognition and management of NCS. The American Clinical Neurophysiology Society's consensus statement recommends a minimum of 24 h to exclude electrographic seizures, while the Neurocritical Care Society's guideline suggests 48 h in patients that are comatose. The use of QEEG amongst electroencephalographers and critical care medicine providers is increasing for NCS detection in critically ill children. The sensitivity and specificity of QEEG to detect NCS ranges from 65 to 83% and 65-92%, respectively. CONCLUSION: The use of cEEG is important to the diagnosis and treatment of NCS or subtle clinical seizures after pediatric CSE. QEEG allows cEEG data to be reviewed and interpreted quickly and is a useful tool for detection of NCS after CSE.


Assuntos
Eletroencefalografia/métodos , Estado Epiléptico/diagnóstico , Eletroencefalografia/normas , Humanos , Estado Epiléptico/fisiopatologia
6.
J Clin Neurophysiol ; 35(6): 510-514, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30216207

RESUMO

PURPOSE: The aim of this study was to assess the variability in EEG reactivity evaluation practices during cardiac arrest prognostication. METHODS: A survey of institutional representatives from North American academic hospitals participating in the Critical Care EEG Monitoring Research Consortium was conducted to assess practice patterns involving EEG reactivity evaluation. This 10-question multiple-choice survey evaluated metrics related to technical, interpretation, personnel, and procedural aspects of bedside EEG reactivity testing and interpretation specific to cardiac arrest prognostication. One response per hospital was obtained. RESULTS: Responses were received from 25 hospitals, including 7 pediatric hospitals. A standardized EEG reactivity protocol was available in 44% of centers. Sixty percent of respondents believed that reactivity interpretation was subjective. Reactivity bedside testing always (100%) started during hypothermia and was performed daily during monitoring in the majority (71%) of hospitals. Stimulation was performed primarily by neurodiagnostic technologists (76%). The mean number of activation procedures modalities tested was 4.5 (SD 2.1). The most commonly used activation procedures were auditory (83.3%), nail bed pressure (63%), and light tactile stimuli (63%). Changes in EEG amplitude alone were not considered consistent with EEG reactivity in 21% of centers. CONCLUSIONS: There is substantial variability in EEG reactivity evaluation practices during cardiac arrest prognostication among North American academic hospitals. Efforts are needed to standardize protocols and nomenclature according with national guidelines and promote best practices in EEG reactivity evaluation.


Assuntos
Envelhecimento/fisiologia , Ondas Encefálicas/fisiologia , Coma/diagnóstico , Coma/etiologia , Eletroencefalografia , Parada Cardíaca/complicações , Padrões de Prática Médica , Adulto , Feminino , Humanos , Cooperação Internacional , Masculino , América do Norte/epidemiologia , Resistência Física , Prognóstico , Estudos Retrospectivos , Inquéritos e Questionários
7.
Crit Care Med ; 46(12): e1105-e1111, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30188384

RESUMO

OBJECTIVES: To compare the performance of critical care providers with that of electroencephalography experts in identifying seizures using quantitative electroencephalography display tools. DESIGN: Diagnostic accuracy comparison among healthcare provider groups. SETTING: Multispecialty quaternary children's hospital in Canada. SUBJECTS: ICU fellows, ICU nurses, neurophysiologists, and electroencephalography technologists. INTERVENTION: Two-hour standardized one-on-one training, followed by a supervised individual review of 27 continuous electroencephalography recordings with the task of identifying individual seizures on eight-channel amplitude-integrated electroencephalography and color density spectral array displays. MEASUREMENTS AND MAIN RESULTS: Each participant reviewed 27 continuous electroencephalograms comprising 487 hours of recording containing a total of 553 seizures. Performance for seizure identification was compared among groups using a nested model analysis with adjustment for interparticipant variability within groups and collinearity among recordings. Using amplitude-integrated electroencephalography, sensitivity for seizure identification was comparable among ICU fellows (83.8%), ICU nurses (73.1%), and neurophysiologists (81.5%) but lower among electroencephalographic technologists (66.7%) (p = 0.003). Using color density spectral array, sensitivity was comparable among ICU fellows (82.4%), ICU nurses (88.2%), neurophysiologists (83.3%), and electroencephalographic technologists (73.3%) (p = 0.09). Daily false-positive rates were also comparable among ICU fellows (2.8 for amplitude-integrated electroencephalography, 7.7 for color density spectral array), ICU nurses (4.2, 7.1), neurophysiologists (1.2, 1.5), and electroencephalographic technologists (0, 0) (p = 0.41 for amplitude-integrated electroencephalography; p = 0.13 for color density spectral array). However, performance varied greatly across individual electroencephalogram recordings. Professional background generally played a greater role in determining performance than individual skill or electroencephalogram recording characteristics. CONCLUSIONS: Following standardized training, critical care providers and electroencephalography experts displayed similar performance for identifying individual seizures using both amplitude-integrated electroencephalography and color density spectral array displays. Although these quantitative electroencephalographic trends show promise as a tool for bedside seizure screening by critical care providers, these findings require confirmation in a real-world ICU environment and in daily clinical use.


Assuntos
Cuidados Críticos/normas , Eletroencefalografia/normas , Pessoal de Saúde/normas , Convulsões/diagnóstico , Canadá , Competência Clínica , Erros de Diagnóstico , Pessoal de Saúde/classificação , Humanos , Capacitação em Serviço/normas , Sensibilidade e Especificidade
8.
Ann Neurol ; 83(6): 1174-1185, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29733464

RESUMO

OBJECTIVE: The optimal treatment of nonconvulsive seizures in critically ill patients is uncertain. We evaluated the comparative effectiveness of the antiseizure drugs lacosamide (LCM) and fosphenytoin (fPHT) in this population. METHODS: The TRENdS (Treatment of Recurrent Electrographic Nonconvulsive Seizures) study was a noninferiority, prospective, multicenter, randomized treatment trial of patients diagnosed with nonconvulsive seizures (NCSs) by continuous electroencephalography (cEEG). Treatment was randomized to intravenous (IV) LCM 400mg or IV fPHT 20mg phenytoin equivalents/kg. The primary endpoint was absence of electrographic seizures for 24 hours as determined by 1 blinded EEG reviewer. The frequency with which NCS control was achieved in each arm was compared, and the 90% confidence interval (CI) was determined. Noninferiority of LCM to fPHT was to be concluded if the lower bound of the CI for relative risk was >0.8. RESULTS: Seventy-four subjects were enrolled (37 LCM, 37 fPHT) between August 21, 2012 and December 20, 2013. The mean age was 63.6 years; 38 were women. Seizures were controlled in 19 of 30 (63.3%) subjects in the LCM arm and 16 of 32 (50%) subjects in the fPHT arm. LCM was noninferior to fPHT (p = 0.02), with a risk ratio of 1.27 (90% CI = 0.88-1.83). Treatment emergent adverse events (TEAEs) were similar in both arms, occurring in 9 of 35 (25.7%) LCM and 9 of 37 (24.3%) fPHT subjects (p = 1.0). INTERPRETATION: LCM was noninferior to fPHT in controlling NCS, and TEAEs were comparable. LCM can be considered an alternative to fPHT in the treatment of NCSs detected on cEEG. Ann Neurol 2018;83:1174-1185.


Assuntos
Anticonvulsivantes/uso terapêutico , Epilepsia Generalizada/tratamento farmacológico , Lacosamida/uso terapêutico , Fenitoína/análogos & derivados , Adulto , Idoso , Idoso de 80 Anos ou mais , Ondas Encefálicas/efeitos dos fármacos , Estudos Cross-Over , Eletroencefalografia , Epilepsia Generalizada/fisiopatologia , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Fenitoína/uso terapêutico , Estudos Prospectivos , Método Simples-Cego , Resultado do Tratamento
9.
Neurol Genet ; 3(6): e199, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29264391

RESUMO

Objective: To expand the clinical phenotype associated with STXBP1 gene mutations and to understand the effect of STXBP1 mutations in the pathogenesis of focal cortical dysplasia (FCD). Methods: Patients with STXBP1 mutations were identified in various ways: as part of a retrospective cohort study of epileptic encephalopathy; through clinical referrals of individuals (10,619) with developmental delay (DD) for chromosomal microarray; and from a collection of 5,205 individuals with autism spectrum disorder (ASD) examined by whole-genome sequencing. Results: Seven patients with heterozygous de novo mutations affecting the coding region of STXBP1 were newly identified. Three cases had radiologic evidence suggestive of FCD. One male patient with early infantile epileptic encephalopathy, DD, and ASD achieved complete seizure remission following resection of dysplastic brain tissue. Examination of excised brain tissue identified mosaicism for STXBP1, providing evidence for a somatic mechanism. Cell-type expression analysis suggested neuron-specific expression. A comprehensive analysis of the published data revealed that 3.1% of severe epilepsy cases carry a pathogenic de novo mutation within STXBP1. By contrast, ASD was rarely associated with mutations in this gene in our large cohorts. Conclusions: STXBP1 mutations are an important cause of epilepsy and are also rarely associated with ASD. In a case with histologically proven FCD, an STXBP1 somatic mutation was identified, suggesting a role in its etiology. Removing such tissue may be curative for STXBP1-related epilepsy.

10.
Curr Opin Neurol ; 30(2): 156-164, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28118303

RESUMO

PURPOSE OF REVIEW: Increasing recognition of electrographic seizures and electrographic status epilepticus in critically ill neonates and children has highlighted the importance of identifying their potential contributions to neurological outcomes to guide optimal management. RECENT FINDINGS: Recent studies in children and neonates have found an independent association between increasing seizure burden and worse short-term and long-term outcomes, even after adjusting for other important contributors to outcome such as seizure cause and illness severity. The risk of worse neurological outcome has been shown to increase above a seizure burden threshold of 12-13 min/h, which is considerably lower than the conventional definition of status epilepticus of 30 min/h. Randomized controlled trials in neonates have demonstrated that electroencephalography-targeted therapy can successfully reduce seizure burden, but due to their small size these trials have not been able to demonstrate that more aggressive electroencephalography-targeted treatment of both subclinical and clinical seizures results in improved outcome. SUMMARY: Despite mounting evidence for an independent association between increasing seizure burden and worse outcome, further study is needed to determine whether early seizure identification and aggressive antiseizure treatment can improve neurodevelopmental outcomes.


Assuntos
Convulsões/fisiopatologia , Estado Epiléptico/fisiopatologia , Estado Terminal , Eletroencefalografia/métodos , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal
11.
Ann Clin Transl Neurol ; 3(9): 708-22, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27648460

RESUMO

OBJECTIVE: To evaluate whether structural and microstructural brain abnormalities in neonates with congenital heart disease (CHD) correlate with neuronal network dysfunction measured by analysis of EEG connectivity. METHODS: We studied a prospective cohort of 20 neonates with CHD who underwent continuous EEG monitoring before surgery to assess functional brain maturation and network connectivity, structural magnetic resonance imaging (MRI) to determine the presence of brain injury and structural brain development, and diffusion tensor MRI to assess brain microstructural development. RESULTS: Neonates with MRI brain injury and delayed structural and microstructural brain development demonstrated significantly stronger high-frequency (beta and gamma frequency band) connectivity. Furthermore, neonates with delayed microstructural brain development demonstrated significantly weaker low-frequency (delta, theta, alpha frequency band) connectivity. Neonates with brain injury also displayed delayed functional maturation of EEG background activity, characterized by greater background discontinuity. INTERPRETATION: These data provide new evidence that early structural and microstructural developmental brain abnormalities can have immediate functional consequences that manifest as characteristic alterations of neuronal network connectivity. Such early perturbations of developing neuronal networks, if sustained, may be responsible for the persistent neurocognitive impairment prevalent in adolescent survivors of CHD. These foundational insights into the complex interplay between evolving brain structure and function may have relevance for a wide spectrum of neurological disorders manifesting early developmental brain injury.

12.
Pediatr Neurol Briefs ; 30(3): 18, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27396956

RESUMO

Investigators from Nationwide Children's Hospital performed an observational cohort study of early post-traumatic seizures (EPTS) among 34 children with moderate to severe traumatic brain injury (TBI) who received levetiracetam (LEV) prophylaxis following admission to their pediatric intensive care unit.

13.
Neurology ; 87(9): 935-44, 2016 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-27466474

RESUMO

OBJECTIVE: To evaluate the sensitivity of quantitative EEG (QEEG) for electrographic seizure identification in the intensive care unit (ICU). METHODS: Six-hour EEG epochs chosen from 15 patients underwent transformation into QEEG displays. Each epoch was reviewed in 3 formats: raw EEG, QEEG + raw, and QEEG-only. Epochs were also analyzed by a proprietary seizure detection algorithm. Nine neurophysiologists reviewed raw EEGs to identify seizures to serve as the gold standard. Nine other neurophysiologists with experience in QEEG evaluated the epochs in QEEG formats, with and without concomitant raw EEG. Sensitivity and false-positive rates (FPRs) for seizure identification were calculated and median review time assessed. RESULTS: Mean sensitivity for seizure identification ranged from 51% to 67% for QEEG-only and 63%-68% for QEEG + raw. FPRs averaged 1/h for QEEG-only and 0.5/h for QEEG + raw. Mean sensitivity of seizure probability software was 26.2%-26.7%, with FPR of 0.07/h. Epochs with the highest sensitivities contained frequent, intermittent seizures. Lower sensitivities were seen with slow-frequency, low-amplitude seizures and epochs with rhythmic or periodic patterns. Median review times were shorter for QEEG (6 minutes) and QEEG + raw analysis (14.5 minutes) vs raw EEG (19 minutes; p = 0.00003). CONCLUSIONS: A panel of QEEG trends can be used by experts to shorten EEG review time for seizure identification with reasonable sensitivity and low FPRs. The prevalence of false detections confirms that raw EEG review must be used in conjunction with QEEG. Studies are needed to identify optimal QEEG trend configurations and the utility of QEEG as a screening tool for non-EEG personnel. CLASSIFICATION OF EVIDENCE REVIEW: This study provides Class II evidence that QEEG + raw interpreted by experts identifies seizures in patients in the ICU with a sensitivity of 63%-68% and FPR of 0.5 seizures per hour.


Assuntos
Ondas Encefálicas/fisiologia , Unidades de Terapia Intensiva , Convulsões/diagnóstico , Convulsões/fisiopatologia , Algoritmos , Eletroencefalografia , Reações Falso-Positivas , Feminino , Humanos , Estudos Longitudinais , Masculino , Sensibilidade e Especificidade , Estatísticas não Paramétricas , Fatores de Tempo
14.
Clin Neurophysiol ; 127(8): 2921-2930, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27266662

RESUMO

OBJECTIVE: Burst-suppression is an electroencephalographic pattern observed during coma. In individuals without known brain pathologies undergoing deep general anesthesia, somatosensory stimulation transiently increases the occurrence of bursts. We investigated the reactivity of burst-suppression in children with acquired brain injury. METHODS: Intensive care unit electroencephalographic monitoring recordings containing burst-suppression were obtained from 5 comatose children with acquired brain injury of various etiologies. Intermittent photic stimulation was performed at 1Hz for 1min to assess reactivity. We quantified reactivity by measuring the change in the burst ratio (fraction of time in burst) following photic stimulation. RESULTS: Photic stimulation evoked bursts in all patients, resulting in a transient increase in the burst ratio, while the mean heart rate remained unchanged. The regression slope of the change in burst ratio, referred to as the standardized burst ratio reactivity, correlated with subjects' Glasgow Coma Scale scores. CONCLUSIONS: Reactivity of the burst-suppression pattern to photic stimulation occurs across diverse coma etiologies. Standardized burst ratio reactivity appears to reflect coma severity. SIGNIFICANCE: Measurement of burst ratio reactivity could represent a simple method to monitor coma severity in critically ill children.


Assuntos
Lesões Encefálicas/fisiopatologia , Ondas Encefálicas/fisiologia , Córtex Cerebral/fisiopatologia , Coma/fisiopatologia , Adolescente , Criança , Pré-Escolar , Eletroencefalografia , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Monitorização Fisiológica , Estimulação Luminosa , Estudos Retrospectivos
16.
J Clin Neurophysiol ; 33(2): 133-40, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26943901

RESUMO

PURPOSE: The rapid expansion of the use of continuous critical care electroencephalogram (cEEG) monitoring and resulting multicenter research studies through the Critical Care EEG Monitoring Research Consortium has created the need for a collaborative data sharing mechanism and repository. The authors describe the development of a research database incorporating the American Clinical Neurophysiology Society standardized terminology for critical care EEG monitoring. The database includes flexible report generation tools that allow for daily clinical use. METHODS: Key clinical and research variables were incorporated into a Microsoft Access database. To assess its utility for multicenter research data collection, the authors performed a 21-center feasibility study in which each center entered data from 12 consecutive intensive care unit monitoring patients. To assess its utility as a clinical report generating tool, three large volume centers used it to generate daily clinical critical care EEG reports. RESULTS: A total of 280 subjects were enrolled in the multicenter feasibility study. The duration of recording (median, 25.5 hours) varied significantly between the centers. The incidence of seizure (17.6%), periodic/rhythmic discharges (35.7%), and interictal epileptiform discharges (11.8%) was similar to previous studies. The database was used as a clinical reporting tool by 3 centers that entered a total of 3,144 unique patients covering 6,665 recording days. CONCLUSIONS: The Critical Care EEG Monitoring Research Consortium database has been successfully developed and implemented with a dual role as a collaborative research platform and a clinical reporting tool. It is now available for public download to be used as a clinical data repository and report generating tool.


Assuntos
Bases de Dados como Assunto , Eletroencefalografia/normas , Projetos de Pesquisa/normas , Adolescente , Adulto , Idoso , Criança , Cuidados Críticos/métodos , Cuidados Críticos/normas , Feminino , Humanos , Colaboração Intersetorial , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Adulto Jovem
17.
Pediatr Crit Care Med ; 17(3): 246-50, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26825045

RESUMO

OBJECTIVES: To analyze barriers to recruitment encountered during a prospective study in the PICU and evaluate strategies implemented to improve recruitment. DESIGN: Prospective observational study of continuous electroencephalogram monitoring in comatose children. SETTING: PICUs at four North American institutions. PATIENTS: Patients with a Glasgow Coma Scale score of less than or equal to 8 for at least an hour. INTERVENTIONS: Four strategies to increase recruitment were sequentially implemented. MEASUREMENTS AND MAIN RESULTS: The baseline enrollment rate was 2.1 subjects/mo, which increased following the single-site introduction of real-time patient screening using an online dashboard (4.5 subjects/mo), deferred consenting (5.2 subjects/mo), and weekend screening (6.1 subjects/mo). However, the subsequent addition of three new study sites was the greatest accelerator of enrollment (21 subjects/mo), representing a 10-fold increase from baseline (p < 0.0001). CONCLUSIONS: Identifying barriers to recruitment and implementing creative strategies to increase recruitment can successfully increase enrollment rates in the challenging ICU environment.


Assuntos
Coma , Unidades de Terapia Intensiva Pediátrica , Seleção de Pacientes , Criança , Eletroencefalografia , Escala de Coma de Glasgow , Humanos , Estudos Observacionais como Assunto , Estudos Prospectivos
18.
Epilepsia ; 56(5): 707-16, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25818041

RESUMO

OBJECTIVE: Epilepsy is a common neurologic disorder of childhood. To determine the genetic diagnostic yield in epileptic encephalopathy, we performed a retrospective cohort study in a single epilepsy genetics clinic. METHODS: We included all patients with intractable epilepsy, global developmental delay, and cognitive dysfunction seen between January 2012 and June 2014 in the Epilepsy Genetics Clinic. Electronic patient charts were reviewed for clinical features, neuroimaging, biochemical investigations, and molecular genetic investigations including targeted next-generation sequencing of epileptic encephalopathy genes. RESULTS: Genetic causes were identified in 28% of the 110 patients: 7% had inherited metabolic disorders including pyridoxine dependent epilepsy caused by ALDH7A1 mutation, Menkes disease, pyridox(am)ine-5-phosphate oxidase deficiency, cobalamin G deficiency, methylenetetrahydrofolate reductase deficiency, glucose transporter 1 deficiency, glycine encephalopathy, and pyruvate dehydrogenase complex deficiency; 21% had other genetic causes including genetic syndromes, pathogenic copy number variants on array comparative genomic hybridization, and epileptic encephalopathy related to mutations in the SCN1A, SCN2A, SCN8A, KCNQ2, STXBP1, PCDH19, and SLC9A6 genes. Forty-five percent of patients obtained a genetic diagnosis by targeted next-generation sequencing epileptic encephalopathy panels. It is notable that 4.5% of patients had a treatable inherited metabolic disease. SIGNIFICANCE: To the best of our knowledge, this is the first study to combine inherited metabolic disorders and other genetic causes of epileptic encephalopathy. Targeted next-generation sequencing panels increased the genetic diagnostic yield from <10% to >25% in patients with epileptic encephalopathy.


Assuntos
Predisposição Genética para Doença , Mutação/genética , Espasmos Infantis/diagnóstico , Espasmos Infantis/genética , Adolescente , Caderinas , Criança , Pré-Escolar , Transtornos Cognitivos/complicações , Transtornos Cognitivos/genética , Estudos de Coortes , Deficiências do Desenvolvimento/complicações , Deficiências do Desenvolvimento/genética , Feminino , Humanos , Lactente , Canal de Potássio KCNQ2 , Masculino , Proteínas Munc18 , Canal de Sódio Disparado por Voltagem NAV1.2 , Trocadores de Sódio-Hidrogênio , Espasmos Infantis/complicações
19.
J Clin Neurophysiol ; 32(2): 96-108, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25626777

RESUMO

INTRODUCTION: Critical Care Continuous EEG (CCEEG) is a common procedure to monitor brain function in patients with altered mental status in intensive care units. There is significant variability in patient populations undergoing CCEEG and in technical specifications for CCEEG performance. METHODS: The Critical Care Continuous EEG Task Force of the American Clinical Neurophysiology Society developed expert consensus recommendations on the use of CCEEG in critically ill adults and children. RECOMMENDATIONS: The consensus panel describes the qualifications and responsibilities of CCEEG personnel including neurodiagnostic technologists and interpreting physicians. The panel outlines required equipment for CCEEG, including electrodes, EEG machine and amplifier specifications, equipment for polygraphic data acquisition, EEG and video review machines, central monitoring equipment, and network, remote access, and data storage equipment. The consensus panel also describes how CCEEG should be acquired, reviewed and interpreted. The panel suggests methods for patient selection and triage; initiation of CCEEG; daily maintenance of CCEEG; electrode removal and infection control; quantitative EEG techniques; EEG and behavioral monitoring by non-physician personnel; review, interpretation, and reports; and data storage protocols. CONCLUSION: Recommended qualifications for CCEEG personnel and CCEEG technical specifications will facilitate standardization of this emerging technology.


Assuntos
Encefalopatias/diagnóstico , Cuidados Críticos/métodos , Estado Terminal , Eletroencefalografia/normas , Monitorização Fisiológica/normas , Adulto , Criança , Eletroencefalografia/métodos , Feminino , Humanos , Masculino , Monitorização Fisiológica/métodos
20.
J Clin Neurophysiol ; 32(2): 87-95, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25626778

RESUMO

INTRODUCTION: Critical Care Continuous EEG (CCEEG) is a common procedure to monitor brain function in patients with altered mental status in intensive care units. There is significant variability in patient populations undergoing CCEEG and in technical specifications for CCEEG performance. METHODS: The Critical Care Continuous EEG Task Force of the American Clinical Neurophysiology Society developed expert consensus recommendations on the use of CCEEG in critically ill adults and children. RECOMMENDATIONS: The consensus panel recommends CCEEG for diagnosis of nonconvulsive seizures, nonconvulsive status epilepticus, and other paroxysmal events, and for assessment of the efficacy of therapy for seizures and status epilepticus. The consensus panel suggests CCEEG for identification of ischemia in patients at high risk for cerebral ischemia; for assessment of level of consciousness in patients receiving intravenous sedation or pharmacologically induced coma; and for prognostication in patients after cardiac arrest. For each indication, the consensus panel describes the patient populations for which CCEEG is indicated, evidence supporting use of CCEEG, utility of video and quantitative EEG trends, suggested timing and duration of CCEEG, and suggested frequency of review and interpretation. CONCLUSION: CCEEG has an important role in detection of secondary injuries such as seizures and ischemia in critically ill adults and children with altered mental status.


Assuntos
Encefalopatias/diagnóstico , Cuidados Críticos/métodos , Estado Terminal , Eletroencefalografia/normas , Monitorização Fisiológica/normas , Adulto , Criança , Eletroencefalografia/métodos , Feminino , Humanos , Masculino , Monitorização Fisiológica/métodos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA