Hemodynamic Changes Associated with Lateralized Periodic Discharges: A Near-Infrared Spectroscopy and Continuous EEG Stu
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ORIGINAL WORK
Hemodynamic Changes Associated with Lateralized Periodic Discharges: A Near‑Infrared Spectroscopy and Continuous EEG Study Nolan Winslow2, Mebin George5, Antonios Michalos3, Huaping Wang4, Erhan Ergene1 and Michael Xu1* © 2020 Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society
Abstract Background: Lateral periodic discharges (LPDs) have been recognized as a common electroencephalographic (EEG) pattern in critically ill patients. However, management decisions in these patients are still a challenge for clinicians. This study investigates hemodynamic changes associated with LPDs and evaluates if this pattern is likely to represent an ictal, interictal, or ictal–interictal continuum phenomenon via non-invasive near infra-red spectroscopy (NIRS) with concurrent with continuous EEG. Methods: Seventeen patients admitted to the intensive care unit with LPDs on continuous electroencephalogram (EEG) were included. Participants engaged in NIRS recording—with scalp probes on right and left frontal regions simultaneously. Associations between LPDs laterality, primary frequency, NIRS a of cerebral oxygen saturation ( SO2), total hemoglobin concentration (tHb), oxygenated hemoglobin concentration (O2Hb), de-oxygenated hemoglobin concentration (HHb), and variables in participant medical history were studied. Results: Hemispheres with LPDs showed higher overall SO2 when compared to non-LPDs hemispheres (57% vs 52%, p = 0.03). Additionally, mildly increased tHb, O2Hb, and mildly decreased HHb concentrations were detected in the hemisphere showing LPDs, but changes were not statistically significant. A higher primary frequency of LPDs was associated with lower cerebral SO2 (Pearson correlation r = − 0.55, p = 0.022) and O2Hb (Pearson correlation r = − 0.52, p = 0.033). In patients with seizure during their EEG recording (64.7%), lower tHb (28.2 μmol/L vs 37.8 μmol/L, p = 0.049) and O2Hb (15.5 μmol/L vs 24.2 μmol/L, p = 0.033) were recorded in the LPDs hemisphere. Conclusions: This study demonstrates an increased cerebral SO2 in the hemisphere with LPDs, and decreased S O2 and O2Hb when the frequency of LPDs increases. The findings indicate that LPDs increase oxygen demand on the ipsilateral hemisphere. We infer that a threshold of LPDs frequency might exit, when the cerebral oxygen demand begins to supersede the ability of delivery, and saturation decreases. Keywords: Lateralized periodic discharges, Seizures, EEG, Near-infrared spectroscopy, Cerebral hemodynamic changes
*Correspondence: [email protected] 1 Department of Neurology, OSF Illinois Neurological Institute, 200 E Pennsylvania Ave, Peoria, IL 61603, USA Full list of author information is available at the end of the article
Introduction Lateral periodic discharges (LPDs) have been recognized as a common EEG pattern in critically ill patients, as there is growing use of continuous EEG in the intensive care setting [1]. LPDs are typically associated with
underlying acute or subacute cerebral s
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