- Email: [email protected]
11. Post-anoxic status epilepticus: The impact of medical treatment on outcome. A single center experience
Abstracts / Clinical Neurophysiology 127 (2016) e323–e341
e325
8. Neurophysiological monitoring and pharmacological provocative test in the endovascular treatment of brain arteriovenous malformations—F. Valzania, S. Contardi, F. Cavallieri, E. Menozzi, S. Vallone, S. Baroni, A. Feletti, G. Pavesi (Modena, Italy)
10. Somatosensory Evoked Potentials as predictors of evolution toward brain death in comatose patients after acquired brain injury—M. Scarpino, G. Lanzo, R. Carrai, F. Lolli, M.L. Migliaccio, M. Spalletti, M. Cozzolino, A. Peris, A. Amantini, A. Grippo (Firenze, Italy)
Neurophysiological monitoring and pharmacological provocative test in the endovascular treatment of brain arteriovenous malformations. The improvement of endovascular techniques increase embolization indications for cerebral arteriovenous malformations (AVMs). Intraoperative monitoring (IOM) techniques are very useful to reduce risks by a step-by-step check of the patient during treatment. We report a series of 5 patients affected by brain AVMs who underwent embolization assisted by IOM and superselective provocative pharmacological test (PTs) with intraarterial amobarbital. We used different IOM setting (MEPs, SEPs, BAERs and VEPs) in relation to the localization of AVM, which was rolandic in 2 patients, brainstem in 2 patients and occipital cortex in one case. We performed six endovascular procedures in five patients, carrying out nine PTs. Changes in IOM signals were detected in 3 out of 5 patients, leading to the decision to partially embolize one AVM and to avoid embolization of 2 other AVMs. No one experienced new permanent neurological deficit. In two patients we achieved complete nidus embolization; in the third patient another endovascular procedure is scheduled with complete resolution of AVM. In any patients we have false negative PTs. The use of IOM during embolization of AVM close to eloquent brain areas, implemented by PTs, is a valuable tool, which allows minimizing the risk of postoperative neurological deficits.
We assessed whether Somatosensory Evoked Potentials (SEPs), recorded within 24 h after ICU admission, are reliable predictors of brain death (BD) in comatose patients with acquired brain injury (ABI) of several aetiologies. SEPs were classified as Absent (A), Pathological (P), and Normal (N). Taking into consideration responses in both hemispheres, six SEP patterns were defined: NN, NP, PP, AN, AP, and AA. The final endpoint was BD. Of the 203 patients, 70 (34%) evolved toward BD. Using survival analysis, the comparison of survival curves indicated that the most powerful aggregation of SEP patterns resulted in the following: grade I (NN-NP-PP-NA) and grade II (AP-AA). This aggregation predicted BD with a sensitivity of 75.7% (CI 64–84) and a specificity of 76.6% (CI 68–83) in overall patients, and with a sensitivity of 75.0% (CI 63–84) and a specificity of 84.9% (CI 75–90) in all patients excluding cardiac arrest. It is worth including SEPs, in association with other instrumental and clinical signs, in prognostic scores of BD. The early identification of patients that would probably evolve toward BD could help physicians to identify potential organ donors and to optimise their diagnostic-therapeutic work-up.
doi:10.1016/j.clinph.2016.10.020
9. Navigated transcranial magnetic stimulation (nTMS) for preoperative mapping in motor areas tumor surgery: Comparison with functional magnetic resonance imaging (fMRI) and intraoperative direct cortical stimulation—C. Lettieri, R. Budai, G. Devigili, F. Muggiolu, S. Rinaldo, R. Canesin, G. Valiante, T. Ius, M. Skrap, R. Eleopra (Udine, Italy)
doi:10.1016/j.clinph.2016.10.022
11. Post-anoxic status epilepticus: The impact of medical treatment on outcome. A single center experience—C. Lettieri, G. Devigili, G. Pauletto, S. Rinaldo, D. Coccolo, V. Cipolat, R. Budai, R. Eleopra (Udine, Italy)
Navigated transcranial magnetic stimulation (nTMS) is a novel technology in the field of neurosurgery for noninvasive delineation of cortical functional topography. Recent studies show that it can detect eloquent cortical areas directly, comparable to intraoperative direct cortical stimulation (DCS). The aim of this study was to evaluate the nTMS in comparison with functional magnetic resonance imaging (fMRI) in the setting of brain tumors involving motor areas. Thirteen consecutive patients affected by frontal lobe brain tumors were enrolled in the study. All patients received an fMRI and nTMS examination preoperatively. Consistency of preoperative mapping with intraoperative DCS was assessed off-line by means of the neuronavigation system: as result, nTMS produced statistically significant higher accuracy scores of the motor area localization than fMRI. Moreover, nTMS has fewer restrictions for preoperative functional mapping than fMRI and requires only a limited level of compliance: so it represents an useful and reliable technique during preoperative planning for surgical decision making in the clinical setting.
In post-anoxic comatose patients, SE is used to be considered a strong poor outcome predictor. The aim of our study was to assess, retrospectively, the outcome of SE after pharmacological treatment with antiepileptic (AEDs) and/or anesthetic drugs in a series of post-anoxic comatose patients and to verify any correlation with other outcome predictors. We retrospectively analyzed data collected from 60 patients affected by hypoxic encephalopathy. Demographic data, SE subtype and duration, coma scale scores (FOUR scale), time of return of spontaneous circulation (ROSC), presence of cortical SSEP (N20), presence of pupillary light reflex, pharmacological treatment and clinical outcome according to Glasgow Outcome Scale (GOS) were evaluated. Finally we performed a statistical analysis by means of a logistic regression. A total of 17 patients showed an EEG pattern consistent to SE. Of them, 12 patients were treated with antiepileptic/anesthetic drugs: 7 patients showed a good outcome (GOS > 2). We found a statistically significant correlation with preserved N20 and anesthetic drugs. Based on our results, we can argue that in post-anoxic encephalopathy, SE doesn’t always correlate with poor outcome especially when other more robust prognostic factors, such as cortical SSEP, are preserved. In such patients, an aggressive antiepileptic treatment could modify prognosis.
doi:10.1016/j.clinph.2016.10.021
doi:10.1016/j.clinph.2016.10.023
e325
8. Neurophysiological monitoring and pharmacological provocative test in the endovascular treatment of brain arteriovenous malformations—F. Valzania, S. Contardi, F. Cavallieri, E. Menozzi, S. Vallone, S. Baroni, A. Feletti, G. Pavesi (Modena, Italy)
10. Somatosensory Evoked Potentials as predictors of evolution toward brain death in comatose patients after acquired brain injury—M. Scarpino, G. Lanzo, R. Carrai, F. Lolli, M.L. Migliaccio, M. Spalletti, M. Cozzolino, A. Peris, A. Amantini, A. Grippo (Firenze, Italy)
Neurophysiological monitoring and pharmacological provocative test in the endovascular treatment of brain arteriovenous malformations. The improvement of endovascular techniques increase embolization indications for cerebral arteriovenous malformations (AVMs). Intraoperative monitoring (IOM) techniques are very useful to reduce risks by a step-by-step check of the patient during treatment. We report a series of 5 patients affected by brain AVMs who underwent embolization assisted by IOM and superselective provocative pharmacological test (PTs) with intraarterial amobarbital. We used different IOM setting (MEPs, SEPs, BAERs and VEPs) in relation to the localization of AVM, which was rolandic in 2 patients, brainstem in 2 patients and occipital cortex in one case. We performed six endovascular procedures in five patients, carrying out nine PTs. Changes in IOM signals were detected in 3 out of 5 patients, leading to the decision to partially embolize one AVM and to avoid embolization of 2 other AVMs. No one experienced new permanent neurological deficit. In two patients we achieved complete nidus embolization; in the third patient another endovascular procedure is scheduled with complete resolution of AVM. In any patients we have false negative PTs. The use of IOM during embolization of AVM close to eloquent brain areas, implemented by PTs, is a valuable tool, which allows minimizing the risk of postoperative neurological deficits.
We assessed whether Somatosensory Evoked Potentials (SEPs), recorded within 24 h after ICU admission, are reliable predictors of brain death (BD) in comatose patients with acquired brain injury (ABI) of several aetiologies. SEPs were classified as Absent (A), Pathological (P), and Normal (N). Taking into consideration responses in both hemispheres, six SEP patterns were defined: NN, NP, PP, AN, AP, and AA. The final endpoint was BD. Of the 203 patients, 70 (34%) evolved toward BD. Using survival analysis, the comparison of survival curves indicated that the most powerful aggregation of SEP patterns resulted in the following: grade I (NN-NP-PP-NA) and grade II (AP-AA). This aggregation predicted BD with a sensitivity of 75.7% (CI 64–84) and a specificity of 76.6% (CI 68–83) in overall patients, and with a sensitivity of 75.0% (CI 63–84) and a specificity of 84.9% (CI 75–90) in all patients excluding cardiac arrest. It is worth including SEPs, in association with other instrumental and clinical signs, in prognostic scores of BD. The early identification of patients that would probably evolve toward BD could help physicians to identify potential organ donors and to optimise their diagnostic-therapeutic work-up.
doi:10.1016/j.clinph.2016.10.020
9. Navigated transcranial magnetic stimulation (nTMS) for preoperative mapping in motor areas tumor surgery: Comparison with functional magnetic resonance imaging (fMRI) and intraoperative direct cortical stimulation—C. Lettieri, R. Budai, G. Devigili, F. Muggiolu, S. Rinaldo, R. Canesin, G. Valiante, T. Ius, M. Skrap, R. Eleopra (Udine, Italy)
doi:10.1016/j.clinph.2016.10.022
11. Post-anoxic status epilepticus: The impact of medical treatment on outcome. A single center experience—C. Lettieri, G. Devigili, G. Pauletto, S. Rinaldo, D. Coccolo, V. Cipolat, R. Budai, R. Eleopra (Udine, Italy)
Navigated transcranial magnetic stimulation (nTMS) is a novel technology in the field of neurosurgery for noninvasive delineation of cortical functional topography. Recent studies show that it can detect eloquent cortical areas directly, comparable to intraoperative direct cortical stimulation (DCS). The aim of this study was to evaluate the nTMS in comparison with functional magnetic resonance imaging (fMRI) in the setting of brain tumors involving motor areas. Thirteen consecutive patients affected by frontal lobe brain tumors were enrolled in the study. All patients received an fMRI and nTMS examination preoperatively. Consistency of preoperative mapping with intraoperative DCS was assessed off-line by means of the neuronavigation system: as result, nTMS produced statistically significant higher accuracy scores of the motor area localization than fMRI. Moreover, nTMS has fewer restrictions for preoperative functional mapping than fMRI and requires only a limited level of compliance: so it represents an useful and reliable technique during preoperative planning for surgical decision making in the clinical setting.
In post-anoxic comatose patients, SE is used to be considered a strong poor outcome predictor. The aim of our study was to assess, retrospectively, the outcome of SE after pharmacological treatment with antiepileptic (AEDs) and/or anesthetic drugs in a series of post-anoxic comatose patients and to verify any correlation with other outcome predictors. We retrospectively analyzed data collected from 60 patients affected by hypoxic encephalopathy. Demographic data, SE subtype and duration, coma scale scores (FOUR scale), time of return of spontaneous circulation (ROSC), presence of cortical SSEP (N20), presence of pupillary light reflex, pharmacological treatment and clinical outcome according to Glasgow Outcome Scale (GOS) were evaluated. Finally we performed a statistical analysis by means of a logistic regression. A total of 17 patients showed an EEG pattern consistent to SE. Of them, 12 patients were treated with antiepileptic/anesthetic drugs: 7 patients showed a good outcome (GOS > 2). We found a statistically significant correlation with preserved N20 and anesthetic drugs. Based on our results, we can argue that in post-anoxic encephalopathy, SE doesn’t always correlate with poor outcome especially when other more robust prognostic factors, such as cortical SSEP, are preserved. In such patients, an aggressive antiepileptic treatment could modify prognosis.
doi:10.1016/j.clinph.2016.10.021
doi:10.1016/j.clinph.2016.10.023