Waziri Allen, Claassen Jan, Stuart R Morgan, Arif Hiba, Schmidt J Michael, Mayer Stephan A, Badjatia Neeraj, Kull Lewis L, Connolly E Sander, Emerson Ronald G, Hirsch Lawrence J
Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA.
Ann Neurol. 2009 Sep;66(3):366-77. doi: 10.1002/ana.21721.
Continuous electroencephalography (EEG) is used in patients with neurological injury to detect electrographic seizures and clinically important changes in brain function. Scalp EEG has poor spatial resolution, is often contaminated by artifact, and frequently demonstrates activity that is suspicious for but not diagnostic of ictal activity. We hypothesized that bedside placement of an intracortical multicontact electrode would allow for improved monitoring of cortical potentials in critically ill neurological patients.
Sixteen individuals with brain injury, requiring invasive neuromonitoring, underwent implantation of an eight-contact minidepth electrode.
Intracortical EEG (ICE) was successfully performed and compared with scalp EEG in 14 of these 16 individuals. ICE provided considerable improvement in signal-to-noise ratio compared with surface EEG, demonstrating clinically important findings in 12 of 14 patients (86%) including electrographic seizures (n = 10) and acute changes related to secondary neurological injury (n = 2, 1 ischemia, 1 hemorrhage). In patients with electrographic seizures detected by ICE, scalp EEG demonstrated no concurrent ictal activity in six, nonictal-appearing rhythmic delta in two, and intermittently correlated ictal activity in two. In two patients with secondary neurological complications, ICE demonstrated prominent attenuation 2 to 6 hours before changes in other neuromonitoring modalities and more than 8 hours before the onset of clinical deterioration.
ICE can provide high-fidelity intracranial EEG in an intensive care unit setting, can detect ictal discharges not readily apparent on scalp EEG, and can identify early changes in brain activity caused by secondary neurological complications. We predict that ICE will facilitate the development of EEG-based alarm systems and lead to prevention of secondary neuronal injury.
连续脑电图（EEG）用于神经损伤患者，以检测脑电图癫痫发作和脑功能的临床重要变化。头皮脑电图的空间分辨率差，常被伪迹干扰，且频繁显示出可疑但不能诊断为发作期活动的脑电活动。我们假设在床边放置皮层内多触点电极可改善对重症神经科患者皮层电位的监测。
16例需要进行有创神经监测的脑损伤患者接受了八触点微型深度电极植入。
这16例患者中有14例成功进行了皮层内脑电图（ICE）检查，并与头皮脑电图进行了比较。与表面脑电图相比，ICE的信噪比有显著提高，14例患者中有12例（86%）显示出临床重要发现，包括脑电图癫痫发作（n = 10）和与继发性神经损伤相关的急性变化（n = 2，1例缺血，1例出血）。在ICE检测到脑电图癫痫发作患者中，头皮脑电图在6例中未显示同步发作期活动，2例显示非发作期节律性δ波，2例显示间歇性相关发作期活动。在2例继发性神经并发症患者中，ICE在其他神经监测方式出现变化前2至6小时以及临床恶化开始前8小时以上显示出明显衰减。
ICE可在重症监护病房环境中提供高保真颅内脑电图，能检测头皮脑电图上不易察觉的发作期放电，并能识别由继发性神经并发症引起的脑活动早期变化。我们预测ICE将促进基于脑电图的警报系统的发展，并有助于预防继发性神经元损伤。
