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Herman S.T.,Beth Israel Deaconess Medical Center | Abend N.S.,University of Pennsylvania | Bleck T.P.,Rush University Medical Center | Chapman K.E.,University of Colorado at Boulder | And 15 more authors.
Journal of Clinical Neurophysiology | Year: 2015

Introduction: Critical Care Continuous EEG (CCEEG) is a common procedure to monitor brain function in patients with altered mental status in intensive care units. There is significant variability in patient populations undergoing CCEEG and in technical specifications for CCEEG performance. Methods: The Critical Care Continuous EEG Task Force of the American Clinical Neurophysiology Society developed expert consensus recommendations on the use of CCEEG in critically ill adults and children. Recommendations: The consensus panel recommends CCEEG for diagnosis of nonconvulsive seizures, nonconvulsive status epilepticus, and other paroxysmal events, and for assessment of the efficacy of therapy for seizures and status epilepticus. The consensus panel suggests CCEEG for identification of ischemia in patients at high risk for cerebral ischemia; for assessment of level of consciousness in patients receiving intravenous sedation or pharmacologically induced coma; and for prognostication in patients after cardiac arrest. For each indication, the consensus panel describes the patient populations for which CCEEG is indicated, evidence supporting use of CCEEG, utility of video and quantitative EEG trends, suggested timing and duration of CCEEG, and suggested frequency of review and interpretation. Conclusion: CCEEG has an important role in detection of secondary injuries such as seizures and ischemia in critically ill adults and children with altered mental status © 2015 by the American Clinical Neurophysiology Society.


Herman S.T.,Beth Israel Deaconess Medical Center | Abend N.S.,University of Pennsylvania | Bleck T.P.,Rush University Medical Center | Chapman K.E.,University of Colorado at Boulder | And 15 more authors.
Journal of Clinical Neurophysiology | Year: 2015

Introduction: Critical Care Continuous EEG (CCEEG) is a common procedure to monitor brain function in patients with altered mental status in intensive care units. There is significant variability in patient populations undergoing CCEEG and in technical specifications for CCEEG performance. Methods: The Critical Care Continuous EEG Task Force of the American Clinical Neurophysiology Society developed expert consensus recommendations on the use of CCEEG in critically ill adults and children. Recommendations: The consensus panel describes the qualifications and responsibilities of CCEEG personnel including neurodiagnostic technologists and interpreting physicians. The panel outlines required equipment for CCEEG, including electrodes, EEG machine and amplifier specifications, equipment for polygraphic data acquisition, EEG and video review machines, central monitoring equipment, and network, remote access, and data storage equipment. The consensus panel also describes how CCEEG should be acquired, reviewed and interpreted. The panel suggests methods for patient selection and triage; initiation of CCEEG; daily maintenance of CCEEG; electrode removal and infection control; quantitative EEG techniques; EEG and behavioral monitoring by non-physician personnel; review, interpretation, and reports; and data storage protocols. Conclusion: Recommended qualifications for CCEEG personnel and CCEEG technical specifications will facilitate standardization of this emerging technology © 2015 by the American Clinical Neurophysiology Society..


Hall K.S.,Geriatric Research | Crowley G.M.,Neurodiagnostic Center | Bosworth H.B.,Veterans Affairs Medical Center | Howard T.A.,Geriatric Research | Morey M.C.,Geriatric Research
Journal of Aging and Physical Activity | Year: 2010

The purpose of this study was to examine what happens to goals over the course of a physical activity counseling trial in older veterans. At baseline, participants (N = 313) identified 1 health-related goal and 1 walking goal for their participation in the study and rated where they perceived themselves to be relative to that goal at the current time. They rated their current status on these same goals again at 6 and 12 mo. Growth-curve analyses were used to examine longitudinal change in perceived goal status. Although both the intervention and control groups demonstrated improvement in their perceived proximity to their health-related and walking goals (L = 1.19, p <.001), the rates of change were significantly greater in the intervention group (β = -.30, p <.05). Our results demonstrate that this physical activity counseling intervention had a positive impact on self-selected goals over the course of the intervention. © 2010 Human Kinetics, Inc.


Tsuchida T.N.,George Washington University | Acharya J.N.,Pennsylvania State University | Halford J.J.,Medical University of South Carolina | Kuratani J.D.,Kaiser Permanente | And 5 more authors.
Journal of Clinical Neurophysiology | Year: 2016

This revision to the EEG Guidelines is an update incorporating current EEG technology and practice. "Standards of practice in clinical electroencephalography" (previously Guideline 4) has been removed. It is currently undergoing revision through collaboration among multiple medical societies and will become part of "Qualifications and Responsibilities of Personnel Performing and Interpreting Clinical Neurophysiology Procedures." The remaining guidelines are reordered and renumbered. © 2016 by the American Clinical Neurophysiology Society.


Wasim M.,Duke University | Husain A.M.,Duke University | Husain A.M.,Neurodiagnostic Center
Current Treatment Options in Neurology | Year: 2015

Nonconvulsive seizures (NCS) occur in as many as 20 % of comatose critically ill patients. These seizures need to be treated; however, the urgency with which this must be done and the medications that should be used are unclear. Often, data from treatment of convulsive status epilepticus (SE) is used to determine the best therapy for NCS. This may lead to “overtreatment” with sedating medications that prolongs hospitalization and worsens outcome. Nonsedating antiepileptic drug (AED) use is favored by many neurologists as the side effect profile is superior to sedating medications. Though limited, the available data suggests that valproic acid and lacosamide may be preferable to phenytoin/fosphenytoin and levetiracetam based on efficacy and side effect profiles. Other AEDs such as topiramate and pregabalin have also been used, but their data is even more limited, and they do not have an intravenous formulation. Clinical trials that have recently been completed and those that are ongoing will further inform our decisions about which drugs to use in the future. © 2015, Springer Science+Business Media New York (outside the USA).


Swisher C.B.,Duke University | Shah D.,Duke University | Sinha S.R.,Duke University | Sinha S.R.,Neurodiagnostic Center | And 2 more authors.
Journal of Clinical Neurophysiology | Year: 2015

Purpose: To identify the probability of detecting nonconvulsive seizures based on the initial pattern seen in the first 30 minutes of continuous EEG (cEEG) monitoring. Methods: Continuous EEG monitoring reports from 243 adult patients were reviewed, assessing the baseline cEEG monitoring pattern and the presence of seizures during the entire monitoring period. The baseline EEG patterns were classified into nine categories: seizures, lateralized periodic discharges, generalized periodic discharges, focal epileptiform discharges, burst suppression, asymmetric background, generalized slowing, generalized periodic discharges with triphasic morphology, and normal. Results: Overall, 51 patients (21%) had nonconvulsive seizures at any time during cEEG monitoring. Notably, 112 patients had generalized slowing as the initial EEG pattern, and none of these patients were noted to have seizures. Seizure rates among the types of baseline EEG findings were as follows: lateralized periodic discharges (56%, n = 9), burst suppression (50%, n = 10), generalized periodic discharges (50%, n = 2), normal (33%, n = 3), focal epileptiform discharges (31%, n = 35), and asymmetric background (11%, n = 46). Conclusions: Patients with only generalized slowing seen on the baseline EEG recording are unlikely to develop seizures on subsequent cEEG monitoring. Depending on the clinical circumstance, the standard duration of cEEG recording (24-48 hours) may be unnecessary in patients with generalized slowing as their only cEEG abnormality © 2015 by the American Clinical Neurophysiology Society..


Swisher C.B.,Duke University | Doreswamy M.,Duke University | Husain A.M.,Duke University | Husain A.M.,Neurodiagnostic Center
Seizure | Year: 2013

Purpose: To determine the efficacy of pregabalin (PGB) in treatment of frequent nonconvulsive seizures (NCS) and nonconvulsive status epilepticus (NCSE) in critically ill patients. Methods: In this retrospective study, 21 patients were identified as having received pregabalin for the treatment of NCS as determined by continuous electroencephalographic monitoring. The patients were considered to be responders if their seizures were terminated within 24 h of initiation of PGB without the addition of another antiepileptic agent. Results: Of the 21 patients who received PGB for treatment of NCS or NCSE, 11 (52%) were responders. PGB was administered via a nasogastric tube or orally and was the 2nd to 4th agent used. The average initial dose and total daily dose of PGB was similar in the responders and non-responders (342 mg vs. 360 mg, respectively). PGB was more effective in aborting NCS (9 patients, 82%) than NCSE (2 patients, 18%). Of the 9 brain tumor patients, PGB resulted in seizure cessation in 67% (6 patients). In contrast, all patients with hypoxic injury (4) did not respond to PGB. The responders were noted to have better clinical outcome (64% vs. 9% discharged home). Most of the patients tolerated the medication without any significant short term adverse effects, except two patients who were noted to have dizziness and sedation. Conclusions: Pregabalin may be safe option for add-on treatment for nonconvulsive seizures in critically ill patients when conventional therapy fails. © 2012 British Epilepsy Association.


Luedke M.W.,Duke University | Luedke M.W.,Neurodiagnostic Center | Pietak M.R.,Duke University | Serafini S.,Duke University | And 3 more authors.
Journal of Clinical Neurophysiology | Year: 2016

MRI-guided laser-interstitial thermal therapy is a new modality for epilepsy surgery. In patients with intractable localization-related seizures, it has been used to ablate epileptogenic lesions with less morbidity than conventional craniotomies, and with potentially similar rates of seizure freedom. It is gaining favor in the treatment of mesial temporal sclerosis, in which the circumscribed epileptic focus is amenable to a stereotactic approach. In some centers, intraoperative electrocorticography (ECoG) is a standard procedure during tailored temporal lobectomies that include resection of mesial temporal structures. Results of intraoperative ECoG have been used to guide the extent of resection of mesial temporal structures and for prognostication. Given the limitations of burr-hole access during laser-interstitial thermal therapy, ECoG has not previously been applied. We present two case reports involving intraoperative ECoG monitoring with a depth electrode placed into the parahippocampal region, with recording before and immediately after thermal ablation of the mesial temporal region. In each case, there were decreases in the mesial temporal spike activity after laser ablation of the hippocampus. This is the first demonstration of intraoperative neurophysiologic motoring during laser-interstitial thermal therapy. The role of intraoperative ECoG for guiding the extent of ablation and determining prognosis during MRI-guided laser-interstitial thermal therapy remains to be determined. © 2016 by the American Clinical Neurophysiology Society.


Singh R.,Duke University | Husain A.M.,Duke University | Husain A.M.,Neurodiagnostic Center
Journal of Clinical Neurophysiology | Year: 2011

Neurophysiologic intraoperative monitoring (NIOM) of the glossopharyngeal and vagus nerves (CN IX and X) is often used during surgeries involving the lower brain stem. Although both of these nerves contain sensory, autonomic, and motor fibers, it is the motor fibers that are most amenable to NIOM. CN IX supplies the stylopharyngeus muscle, and CN X supplies striated muscles in the soft palate, pharynx, and larynx. Monitoring of these CN can be performed by monitoring free running and stimulated electromyography (EMG) from the stylopharyngeus muscle (CN IX) and the vocal cords (CN X). Various surface and needle electrodes can be used to monitor these muscle groups. When CN IX is monitored, CN X should also be monitored, as it is often needed to differentiate when CN IX is selectively activated. Data are accumulating noting the use of monitoring these CN in tumor surgeries involving the lower brain stem. Copyright © 2011 by the American Clinical Neurophysiology Society.


Hall K.S.,Geriatric Research | Sloane R.,Duke University | Pieper C.F.,Duke University | Peterson M.J.,Geriatric Research | And 10 more authors.
Journal of Aging Research | Year: 2011

This study assessed the sustained effect of a physical activity (PA) counseling intervention on PA one year after intervention, predictors of sustained PA participation, and three classes of post-intervention PA trajectories (improvers, maintainers, and decliners) in 238 older Veterans. Declines in minutes of PA from 12 to 24 months were observed for both the treatment and control arms of the study. PA at 12 months was the strongest predictor of post-intervention changes in PA. To our surprise, those who took up the intervention and increased PA levels the most, had significant declines in post-intervention PA. Analysis of the three post-intervention PA trajectories demonstrated that the maintenance group actually reflected a group of nonresponders to the intervention who had more comorbidities, lower self-efficacy, and worse physical function than the improvers or decliners. Results suggest that behavioral counseling/support must be ongoing to promote maintenance. Strategies to promote PA appropriately to subgroups of individuals are needed. © 2011 Katherine S. Hall et al.

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