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Neurophysiological assessment of brain dysfunction in critically ill patients: an update

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Abstract

The aim of this review was to provide up-to-date information about the usefulness of clinical neurophysiology testing in the management of critically ill patients. Evoked potentials (EPs) and electroencephalogram (EEG) are non-invasive clinical neurophysiology tools that allow an objective assessment of the central nervous system’s function at the bedside in intensive care unit (ICU). These tests are quite useful in diagnosing cerebral complications, and establishing the vital and functional prognosis in ICU. EEG keeps a particularly privileged importance in detecting seizures phenomena such as subclinical seizures and non-convulsive status epilepticus. Quantitative EEG (QEEG) analysis techniques commonly called EEG Brain mapping can provide obvious topographic displays of digital EEG signals characteristics, showing the potential distribution over the entire scalp including filtering, frequency, and amplitude analysis and color mapping. Evidences of usefulness of QEEG for seizures detection in ICU are provided by several recent studies. Furthermore, beyond detection of epileptic phenomena, changes of some QEEG panels are early warning indicators of sedation level as well as brain damage or dysfunction in ICU. EPs offer the opportunity for assessing brainstem’s functional integrity, as well as subcortical and cortical brain areas. A multimodal use, combining EEG and various modalities of EPs is recommended since this allows a more accurate functional exploration of the brain and helps caregivers to tailor therapeutic measures according to neurological worsening trends and to anticipate the prognosis in ICU.

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Authors and Affiliations

  1. Department of Physiology and Department of Critical Care Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), Raymond Poincaré Hospital, INSERM U1173, University of Versailles Saint Quentin-En-Yvelines (UVSQ), 104 Boulevard Raymond Poincaré, Garches, 92380, Paris, France

    Eric Azabou, Djillali Annane, Fréderic Lofaso & Tarek Sharshar

  2. Department of Clinical Neurophysiology, Hospices Civils de Lyon, Neurological Hospital of Lyon, Lyon Neuroscience Research Center (CRNL), Brain Dynamics and Cognition Team (Dycog), INSERM U1028, CNRS UMR5292, Université Lyon 1, Lyon, France

    Catherine Fischer & François Mauguiere

  3. Department of Clinical Neurophysiology, CHIREC, Hôpital Edith Cavell, 1180, Bruxelles, Belgium

    Jean Michel Guerit

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  1. Eric Azabou
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Azabou, E., Fischer, C., Guerit, J.M. et al. Neurophysiological assessment of brain dysfunction in critically ill patients: an update. Neurol Sci 38, 715–726 (2017). https://doi.org/10.1007/s10072-017-2824-x

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