Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society
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J Clin Neurophysiol · Sep 2004
ReviewData analysis for continuous EEG monitoring in the ICU: seeing the forest and the trees.
Continuous EEG monitoring (CEEG) is a powerful tool for evaluating cerebral function in obtunded and comatose critically ill patients. The ongoing analysis of CEEG data is a major task because of the volume of data generated during monitoring and the need for near real-time interpretation of a patient's EEG patterns. Advances in digital EEG data acquisition, computer processing, data transmission, and data display have made CEEG monitoring in the intensive care unit technically feasible. ⋯ These tools reduce the tremendous time burdens that accompany analysis of the complete CEEG data stream, and allow bedside personnel and nonexpert staff to potentially recognize significant EEG changes in a timely fashion. This article uses literature review and clinical case examples to illustrate techniques for the display and analysis of intensive care unit CEEG recordings. Areas requiring further research and development are discussed.
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Seizures and status epilepticus (SE) are serious complications in intensive care unit (ICU) patients. SE is often divided into convulsive and nonconvulsive types, based on clinical features. The EEG is helpful in further dividing SE into those that are generalized from onset, or have a partial onset, because this may be difficult to do clinically. ⋯ Furthermore, although an EEG is required to verify the diagnosis, there are not widely accepted criteria to diagnose this entity, particularly in obtunded/comatose patients. For example, it is controversial whether several EEG patterns, such as periodic lateralized and generalized periodic epileptiforms, are ictal or interictal. This article reviews EEG findings in different types of SE in adults and provides numerous examples.
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J Clin Neurophysiol · Jul 2004
Biography Historical ArticleMind, brain, body, and soul: a review of the electrophysiological undercurrents for Dr. Frankenstein.
Mary Shelley's Frankenstein is perhaps the most famous work of medical science fiction. She and her husband, the poet Percy Shelley, were aware of nascent neuroscience experimentation and the effects of electricity on neuromuscular function. ⋯ These demonstrations and theories find expression in Frankenstein and provide models for Dr. Frankenstein and his creation.
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Within the past few years, there has been a renaissance of functional neurosurgery for the treatment of dystonic movement disorders. In particular, deep brain stimulation (DBS) has widened the spectrum of therapeutical options for patients with otherwise intractable dystonia. It has been introduced only with a delay after DBS became an accepted treatment for advanced Parkinson' disease (PD). ⋯ Because more energy is needed for stimulation than in other movement disorders such as PD, more frequent battery replacements are necessary, which results in relatively higher costs for chronic DBS. The study of intraoperative microelectrode recordings and of local field potentials by the implanted DBS electrodes has yielded new insights in the pathophysiology of dystonia. Larger studies are underway presently to validate the observations being made.
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J Clin Neurophysiol · Jan 2004
ReviewDeep brain stimulation for the treatment of Parkinson's disease.
Deep brain stimulation (DBS) is increasingly accepted as an adjunct therapy for Parkinson's disease (PD). It is considered a surgical treatment alternative for patients with intractable tremor or for those patients who are affected by long-term complications of levodopa therapy such as motor fluctuations and severe dyskinesias. Thalamic stimulation in the ventral intermediate nucleus (Vim) leads to a marked reduction of contralateral tremor but has no beneficial effect on other symptoms of Parkinson's disease. ⋯ More recently, however, a number of reports on possible psychiatric and behavioral side effects of STN-DBS have been a matter of concern. Given the chronic nature of PD and the noncurative approach of DBS, both targets will need to be reevaluated on the basis of their long-term efficacy and their impact on quality of life. Despite the rapidly increasing numbers of DBS procedures, surprisingly few controlled clinical trials are available that address important clinical issues such as: When should DBS be applied during the course of disease? Which patients should be selected? Which target should be considered? Which guidelines should be followed during postoperative care? Here is summarized the available evidence on DBS as a therapeutic tool for the treatment of Parkinson's disease and the current state of debate on open issues.