Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society
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J Clin Neurophysiol · Sep 2004
ReviewEmergency EEG and continuous EEG monitoring in acute ischemic stroke.
There is physiologic coupling of EEG morphology, frequencies, and amplitudes with cerebral blood flow. Intraoperative continuous electroencephalographic monitoring (CEEG) is an established modality that has been used for 30 years to detect cerebral ischemia during carotid surgery. These facts have generated interest in applying EEG/CEEG in the intensive care unit to monitor cerebral ischemia. ⋯ This review presents evidence that EEG/CEEG adds value to early diagnosis, outcome prediction, patient selection for treatment, clinical management, and seizure detection in AIS. Research studies correlating EEG/CEEG and advanced imaging techniques in AIS are encouraged. Improvements in real-time ischemia detection systems are needed for EEG/CEEG to have wider application in AIS.
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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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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.
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This review describes the wide spectrum of episodic phenomena that can occur during sleep. These phenomena include arousal disorders of nonrapid eye movement (NREM) sleep, rapid eye movement (REM) sleep behavior disorder, movement disorders, psychiatric disorders, and epileptic seizures. Each of these entities is discussed in detail, focusing on their clinical manifestations, diagnosis, and treatment. Essential historic elements that distinguish these events and the role of video-EEG-polysomnography in their differential diagnosis are emphasized.