Electrophysiologic Monitoring in Acute Brain Injury

Abstract

To determine the optimal use and indications of electroencephalography (EEG) in critical care management of acute brain injury (ABI). An electronic literature search was conducted for articles in English describing electrophysiological monitoring in ABI from January 1990 to August 2013. A total of 165 studies were included. EEG is a useful monitor for seizure and ischemia detection. There is a well-described role for EEG in convulsive status epilepticus and cardiac arrest (CA). Data suggest EEG should be considered in all patients with ABI and unexplained and persistent altered consciousness and in comatose intensive care unit (ICU) patients without an acute primary brain condition who have an unexplained impairment of mental status. There remain uncertainties about certain technical details, e.g., the minimum duration of EEG studies, the montage, and electrodes. Data obtained from both EEG and EP studies may help estimate prognosis in ABI patients, particularly following CA and traumatic brain injury. Data supporting these recommendations is sparse, and high quality studies are needed. EEG is used to monitor and detect seizures and ischemia in ICU patients and indications for EEG are clear for certain disease states, however, uncertainty remains on other applications.

Appendix: Participants in the International Multi-disciplinary Consensus Conference on Multimodality Monitoring

Peter Le Roux, MD, FACS,

Brain and Spine Center,

Suite 370, Medical Science Building,

Lankenau Medical Center,

100 East Lancaster Avenue, Wynnewood, PA 19096, USA.

Tel: +1-610-6423005;

Fax: +1-610-6423057

lerouxp@mlhs.org

David K. Menon, MD, PhD, FRCP, FRCA, FFICM, FMedSci

Head, Division of Anaesthesia, University of Cambridge,

Consultant, Neurosciences Critical Care Unit,

Box 93, Addenbrooke’s Hospital,

Cambridge CB2 2QQ, UK

dkm13@wbic.cam.ac.uk

Paul Vespa, MD, FCCM, FAAN, FNCS

Professor of Neurology and Neurosurgery,

Director of Neurocritical Care,

David Geffen School of Medicine at UCLA

Los Angeles, CA 90095, USA

PVespa@mednet.ucla.edu

Giuseppe Citerio,

Director Neurointensive Care Unit,

Department of Anesthesia and Critical Care,

Ospedale San Gerardo, Monza.

Via Pergolesi 33, Monza 20900, Italy

g.citerio@hsgerardo.org

Mary Kay Bader RN, MSN, CCNS, FAHA, FNCS

Neuro/Critical Care CNS,

Mission Hospital,

Mission Viejo, CA 92691, USA

Marykay.Bader@stjoe.org

Gretchen M. Brophy, PharmD, BCPS, FCCP, FCCM

Professor of Pharmacotherapy & Outcomes Science and Neurosurgery,

Virginia Commonwealth University,

Medical College of Virginia Campus,

410 N. 12th Street,

Richmond, VA 23298-0533, USA

gbrophy@vcu.edu

Michael N. Diringer, MD

Professor of Neurology, Neurosurgery & Anesthesiology,

Chief, Neurocritical Care Section,

Washington University,

Dept. of Neurology, Campus Box 8111,

660 S Euclid Ave.,

St Louis, MO 63110, USA

diringerm@neuro.wustl.edu

Nino Stocchetti, MD

Professor of Anesthesia and Intensive Care,

Department of Physiopathology And Transplant,

Milan University,

Director Neuro ICU,

Fondazione IRCCS CàGrandaOspedale Maggiore Policlinico,

Via F Sforza, 35 20122 Milan, Italy

stocchet@policlinico.mi.it

Walter Videtta, MD

ICU Neurocritical Care,

Hospital Nacional ‘Prof. a. Posadas’,

El Palomar – Pcia.de Buenos Aires,

Argentina

wvidetta@ar.inter.net

Rocco Armonda, MD

Department of Neurosurgery,

MedStar Georgetown University Hospital,

MedstarHealth, 3800 ReservoirRoad NW,

Washington DC 20007,

USA

Rocco.Armonda@gmail.com

Neeraj Badjatia, MD

Department of Neurology,

University of Maryland Medical Center,

22 S Greene St.,

Baltimore, MD 21201,

USA

nbadjatia@umm.edu

Julian Boesel, MD

Department of Neurology

Ruprect-Karls University,

Hospital Heidelberg, ImNeuenheimer Feld 400,

D-69120 Heidelberg,

Germany

Julian.Boesel@med.uni-heidelberg.de

Randal Chesnut, MD, FCCM, FACS

Harborview Medical Center,

University of Washington, Mailstop 359766,

325 Ninth Ave.,

Seattle, WA 98104-2499,

USA

chesnutr@u.washington.edu

Sherry Chou, MD, MMSc

Department of Neurology,

Brigham and Women’s Hospital,

75 Francis Street,

Boston, MA 02115,

USA

schou1@partners.org

Jan Claassen, MD, PhD, FNCS

Assistant Professor of Neurology and Neurosurgery,

Head of Neurocritical Care and Medical Director of the Neurological Intensive Care Unit,

Columbia University College of Physicians & Surgeons,

177 Fort Washington Avenue, Milstein 8 Center Room 300,

New York, NY 10032,

USA

jc1439@cumc.columbia.edu

Marek Czosnyka, PhD

Department of Neurosurgery,

University of Cambridge,

Addenbrooke’s Hospital, Box 167,

Cambridge, CB20QQ

United Kingdom

mc141@medschl.cam.ac.uk

Michael De Georgia, MD

Professor of Neurology,

Director, Neurocritical Care Center,

Co-Director, Cerebrovascular Center,

University Hospital Case Medical Center,

Case Western Reserve University School of Medicine,

11100 Euclid Avenue,

Cleveland, OH 44106,

michael.degeorgia@uhhospitals.org

Anthony Figaji, MD, PhD

Head of Pediatric Neurosurgery,

University of Cape Town,

617 Institute for Child Health,

Red Cross Children’s Hospital,

Rondebosch, 7700 Cape Town,

South Africa

anthony.figaji@uct.ac.za

Jennifer Fugate, DO

Department of Neurology,

Mayo Clinic,

200 First Street SW,

Rochester, MN 55905

Fugate.Jennifer@mayo.edu

RaimundHelbok, MD

Department of Neurology, Neurocritical Care Unit,

Innsbruck Medical University,

Anichstr.35, 6020

Innsbruck,

Austria

raimund.helbok@uki.at

David Horowitz, MD

Associate Chief Medical Officer,

University of Pennsylvania Health System,

3701 Market Street,

Philadelphia, PA 19104,

USA

david.horowitz@uphs.upenn.edu

Peter Hutchinson, MD

Professor of Neurosurgery,

NIHR Research Professor,

Department of Clinical Neurosciences,

University of Cambridge,

Box 167 Addenbrooke’s Hospital,

Cambridge CB2 2QQ

United Kingdom

pjah2@cam.ac.uk

Monisha Kumar, MD

Department of Neurology,

Perelman School of Medicine, University of Pennsylvania,

3 West Gates,

3400 Spruce Street,

Philadelphia, PA 19104,

USA

monisha.kumar@uphs.upenn.edu

Molly McNett, RN, PhD

Director, Nursing Research,

The MetroHealth System,

2500 MetroHealth Drive,

Cleveland, OH 44109,

USA

mmcnett@metrohealth.org

Chad Miller, MD

Division of Cerebrovascular Diseases and Neurocritical Care,

The Ohio State University,

395 W. 12th Ave., 7th Floor,

Columbus, OH 43210,

ChadM.Miller@osumc.edu

Andrew Naidech, MD, MSPH

Department of Neurology,

Northwestern University Feinberg SOM 710,

N Lake Shore Drive, 11th Floor,

Chicago, IL 60611

ANaidech@nmff.org

Mauro Oddo, MD

Department of Intensive Care Medicine,

CHUV University Hospital, BH 08-623,

Faculty of Biology and Medicine University of Lausanne,

1011 Lausanne, Switzerland

Mauro.Oddo@chuv.ch

Dai Wai Olson, RN, PhD

Associate Professor of Neurology, Neurotherapeutics and Neurosurgery,

University of Texas Southwestern,

5323 Harry Hines Blvd.,

Dallas, TX 75390-8897

USA

daiwai.olson@utsouthwestern.edu

Kristine O’Phelan, MD

Director of Neurocritical Care,

Associate Professor, Department of Neurology,

University of Miami, Miller School of Medicine,

JMH, 1611 NW 12th Ave., Suite 405,

Miami, FL 33136,

USA

kophelan@med.miami.edu

Javier Provencio, MD

Associate Professor of Medicine,

Cerebrovascular Center and Neuroinflammation Research Center,

Lerner College of Medicine,

Cleveland Clinic,

9500 Euclid Ave, NC30,

Cleveland, OH 44195,

USA

provenj@ccf.org

Corina Puppo, MD

Assistant Professor, Intensive Care Unit,

Hospital de Clinicas, Universidad de la República,

Montevideo,

Uruguay

coripuppo@gmail.com

Richard Riker, MD

Critical Care Medicine,

Maine Medical Center,

22 Bramhall Street,

Portland, ME 04102-3175,

USA

RRiker@cmamaine.com

Claudia Robertson, MD

Department of Neurosurgery,

Medical Director of Center for Neurosurgical Intensive Care,

Ben Taub Hospital,

Baylor College of Medicine,

1504 Taub Loop, Houston, TX 77030,

USA

claudiar@bcm.tmc.edu

J. Michael Schmidt, PhD, MSc

Director of Neuro-ICU Monitoring and Informatics,

Columbia University College of Physicians and Surgeons,

Milstein Hospital 8 Garden South, Suite 331,

177 Fort Washington Avenue,

New York, NY 10032,

USA

mjs2134@columbia.edu

Fabio Taccone, MD

Department of Intensive Care, Laboratoire de Recherche Experimentale,

Erasme Hospital,

Route de Lennik, 808

1070 Brussels,

Belgium

ftaccone@ulb.ac.be