Banks Matthew I, Dappen Emily R, Matar Elie, Hayum Benjamin D, Sutherland Michael H, Krause Bryan M, Kawasaki Hiroto, Sanders Robert D, Nourski Kirill V
Department of Anesthesiology, University of Wisconsin, Madison, WI 53706, USA.
Department of Neurosurgery, The University of Iowa, Iowa City, IA 52242, USA.
Clin Neurophysiol. 2025 Mar;171:38-50. doi: 10.1016/j.clinph.2024.12.023. Epub 2025 Jan 20.
(1) Gain insight into the mechanisms of postoperative delirium (POD). (2) Determine mechanistic overlap with post-ictal delirium (PID). Epilepsy patients undergoing intracranial electrophysiological monitoring can experience both POD and PID, and thus are suitable subjects for these investigations.
POD was assessed daily after surgery. PID was assessed following seizures. Resting state data were collected following delirium assessments, during a control period, and during sleep. Slow-wave activity (SWA: 1-4 Hz) and resting state functional connectivity were compared between different time points and according to delirium status.
POD was present in 6 of 20 participants. Post-operatively, SWA was globally elevated in all participants but highest in POD+ participants. POD+ participants exhibited altered functional connectivity compared to POD-. These differences persisted even after resolution of delirium. PID was present in 7 of 15 participants and was predicted by seizures involving prefrontal cortex. PID+ participants exhibited higher post-ictal SWA versus PID-; no differences in functional connectivity were observed. Post-operative and post-ictal SWA was comparable to sleep in some participants.
Elevated SWA may predispose patients to both post-operative and post-ictal delirium and may indicate overlapping mechanisms.
Delirium treatments focused on SWA may be most effective for ameliorating cognitive symptoms.
（1）深入了解术后谵妄（POD）的机制。（2）确定与发作后谵妄（PID）的机制重叠情况。接受颅内电生理监测的癫痫患者可能会经历POD和PID，因此是这些研究的合适对象。
术后每天评估POD。发作后评估PID。在谵妄评估后、对照期和睡眠期间收集静息态数据。比较不同时间点以及根据谵妄状态的慢波活动（SWA：1 - 4赫兹）和静息态功能连接性。
20名参与者中有6名出现POD。术后，所有参与者的SWA整体升高，但在POD +参与者中最高。与POD -参与者相比，POD +参与者表现出功能连接性改变。即使在谵妄消退后，这些差异仍然存在。15名参与者中有7名出现PID，且由涉及前额叶皮层的发作所预测。与PID -参与者相比，PID +参与者发作后SWA更高；未观察到功能连接性的差异。在一些参与者中，术后和发作后的SWA与睡眠时相当。
SWA升高可能使患者易患术后和发作后谵妄，并可能表明存在重叠机制。
针对SWA的谵妄治疗可能对改善认知症状最有效。
