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Seizure moitoring: a new tool in electroencephalography.

A seizure monitoring system, based on telemetry and computer techniques, has been developed to provide a reliable means of recording the patient's spontaneous seizures. It allows a patient's EEG to be monitored for hours or days with 16 channels of EEG from surface, sphenoidal or stereotaxically implanted depth electrodes, from any ward or room within the hospital. The EGG is delayed in time by up to 4 min by a mini-computer so that either the patient can push a button when he experiences his aura or others can push the button when they observe his seizure. Since the delayed EEG is written out, the preictal, ictal and postictal are recorded on paper, without many pages of uneventful interictal information. During the past 16 months, the seizure monitoring system has been used as a clinical service to examine patients with surface electrodes (42), sphenoidal wires (25) and depth electrodes (7) during 146 recording sessions for over 3200 h of monitoring time while over 200 seizures have been recorded.

Amplifiers, Electronic↗

Automatic noctural sleep sampling: a useful method in clinical electroencephalography.

The clinical usefulness of obtaining a sleep record in epileptic patients is well established. However, in many clinical EEG laboratories, it is difficult to obtain records at night during the patient's natural sleep. Thus, most sleep EEGs are recorded in the EEG laboratory during daytime and are induced by drugs. A 16 channel cable-telemetry system is described which automatically samples throughout the night the EEG of patients while sleeping in their room or ward without the aid of any medication. The electrodes and the cable-telemetry unit are applied to the patient in the afternoon and the system is checked. The patient is then instructed to plug the system into a wall box upon retiring and to disconnect it when he wakes up in the morning. The EEG samples are automatically written out during the night on one of the EEG machines located in the EEG laboratory to which the system is connected via spectral intra-hospital wiring. The duration of the samples and of the intervals separating them can be varied according to the circumstances. We have found this method to be very helpful in the investigation of epileptic patients, especially those considered for surgical treatment.

Electroencephalography↗

Focal positive spikes in electroencephalography.

Focal positive spikes and sharp waves in clinical EEG are uncommon (about 1.3 per 1,000 EEGs in this series) and encountered chiefly in early life. All of out seven patients suffered from a convulsive disorder. These discharges must be differentiated from 14 and 6 c/sec positive bursts. Atifactual electrical transients with apparent focal positivity must always be ruled out. Whenever focal positive spikes and sharp waves are identified, it is advisable to search for simultaneous focal negative discharges. The literature indicates that focal positive spikes and sharp waves could be classified according to the presumed pathophysiological mechanisms and illustrative patients were described.

Action Potentials↗

Electroencephalography in brain edema (127 cases of brain tumor investigated by cranial computerized tomography).

Cranial computerized tomography (CCT) in permitting visualization of cerebral edema in live patients, allows for the first time valid studies concerning the role of reactional edema in the generation of EEG abnormalities related to expanding processes. The authors analyze the results of EEG and CCT in 127 patients presenting cerebral tumor(s), 84 of which were accompanied by reactional edema. The study leads to the conclusion (also demonstrated by certain animal work) that edema per se is only rarely responsible (9.5%) for the EEG abnormalities.

Brain Edema↗

Serial quantitative electroencephalography.

Repeated EEG examinations are often used in diagnostically difficult cases to assess whether an EEG abnormality is progressive, regressive, or stationary. The conventional visual method is, however, poorly adapted to consider the variability when consecutive EEG recordings are compared. Using computer analysis of EEGs, the feature of the recordings as well as their variances can be measured, and the differences between the recordings can be tested statistically. The aim of the present study was to develop a practicable method for quantitative serial EEG examinations. Twenty EEGs from 5 volunteers were recorded to obtain reference data. The data acquisition was automated to obtain data without visual bias. The previously developed method using age ratios was employed for the primary analysis. The changes of the EEG activity during the observation period were evaluated statistically. Differences between consecutive EEGs could be observed even in normal subjects but the number of 'false positive' findings was reduced by the automatic data selection, by the choice of proper measures, and by adequate statistical treatment. The diagnostic value of the method was tested in 59 EEGs from 13 patients with well-defined brain disorders. Most EEG changes which could be attributed to the development of the disease were discovered and labelled as statistically significant.

Adult↗

The usefulness of electroencephalography in curarized newborns.

Curare and other muscle relaxants are being used with increasing frequency in the management of infants who are mechanically ventilated for severe respiratory distress. Neurological evaluation of these paralyzed newborns is difficult and neonatal convulsions may go unrecognized. The present study includes 5 curarized infants in whom neurological impairment was suspected because of complicated pregnancies and perinatal asphyxia. All showed very abnormal EEGs with ongoing paroxysmal activity in the absence of clinical seizures or a severely depressed record. In two of these infants an improvement in the values of the blood-gases coincided with the administration of diazepam. In curarized infants the electroencephalogram is of importance in the evaluation of the background activity, the detection of convulsive brain activity, and in the management of anticonvulsive therapy.

Alpha Rhythm↗

A comparison between electroencephalography and somatosensory evoked potentials for outcome prediction following severe head injury.

The value of somatosensory evoked potentials (SEPs) for the prediction of outcome following severe head injury (HI) is established. The role of the electroencephalogram (EEG) in this setting is uncertain. In this comparative study, SEPs and EEGs were recorded within 3 days of severe HI in 90 patients, and the results related to outcome at 6 months. Patients with an isoelectric EEG or an EEG with repeated isoelectric intervals died. Reactivity of the EEG to external stimulation tended to be associated with favorable outcome. Grading of the EEGs on the basis of frequency composition otherwise provided no prognostic information. The presence of SEP scalp potentials bilaterally predicted favorable outcome, particularly if the central conduction times were normal. Conversely, the absence of one of both scalp potentials was associated with unfavorable outcome. EEGs thus provided useful prognostic information in only a minority of patients. By comparison, SEPs allowed prediction of both favorable and unfavorable outcomes in a much larger number of patients, and were therefore prognostically superior.

Adolescent↗