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Monitoring Severe Head Injury: a Comparison of EEG and Somatosensory Evoked Potentials

Published online by Cambridge University Press:  18 September 2015

Richard J. Moulton ,
Jennifer I.M. Brown  and
Stefan J. Konasiewicz
Richard J. Moulton*
Affiliation:
Division of Neurosurgery, St. Michael's Hospital, and the University of Toronto, Toronto, Ontario
Jennifer I.M. Brown
Affiliation:
Division of Neurosurgery, St. Michael's Hospital, and the University of Toronto, Toronto, Ontario
Stefan J. Konasiewicz
Affiliation:
Division of Neurosurgery, St. Michael's Hospital, and the University of Toronto, Toronto, Ontario
*
Division of Neurosurgery, 38 Shuter Street, Toronto, Ontario, Canada M5B 1A6
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Abstract

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We report on our experience with long-term monitoring of the EEG power spectrum and somatosensory evoked potentials (SSEPs) in 103 patients with severe closed head injury (Glasgow Coma Scale - GCS ≤ 8). Patients were monitored for an average of 5 days post injury and monitoring was terminated when they died, regained consciousness or their intracranial physiologic parameters (primarily intracranial pressure - ICP) were stable for 2-3 days. Patients were treated according to a standard protocol that included mechanical ventilation, sedation, and neuromuscular blockade. At 7 of 9 twelve hour time intervals post injury, SSEPs were significantly (p < .05) different between outcome groups using the Glasgow Outcome Score collapsed to 3 categories. The percent slow (delta) activity in the EEG was not significantly different between outcome groups at any time point, post injury. The total power in the EEG power spectrum differed only at the last time epoch post injury (108 hr.). Based on the superior prognostic capabilities of the SSEP, we routinely base critical management decisions on SSEP values. We have not been able to rely on EEG parameters for these same decisions due to the lack of clear distinction between good and poor prognosis groups based on common EEG parameters.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 25 , Issue S1 , February 1998 , pp. S7 - S11
Copyright
Copyright © Canadian Neurological Sciences Federation 1998

References

REFERENCES

1.Stockard, JJ, Bickford, RG, Aung, MH. The electroencephalogram in traumatic brain injury. In: Vinken, PJ, Bruyn, GW, eds. Handbook of Clinical Neurology, Volume 23, Injuries of the Brain and Skull Part I. Amsterdam: Elsevier, 1975; 317–367.Google Scholar
2.Bickford, RG. Computer analysis of background activity. In: Remond, E, ed. A Didactic Review of Methods and Applications of EEG. Amsterdam: Elsevier, 1977; 215–232.Google Scholar
3.Bricolo, A, Turazzi, S, Faccioli, F, et al. Clinical application of compressed spectral array in long-term EEG monitoring of comatose patients. Electroencephalogr Clin Neurophysiol 1978; 45: 211–225.CrossRefGoogle ScholarPubMed
4.Karnaze, DS, Marshall, LF, Bickford, RG. EEG monitoring of clinical coma: the compressed spectral array. Neurology 1982; 32: 289–292.CrossRefGoogle ScholarPubMed
5.Thatcher, RW, Cantor, DS, McAlaster, R, Geisler, F. Krause, P. Comprehensive predictions of outcome in closed head-injured patients. The development of prognostic equations. Ann N Y Acad Sci 1991; 620: 82–101.CrossRefGoogle Scholar
6.Newlon, PG, Greenberg, RP, Hyatt, MS, et al. The dynamics of neuronal dysfunction and recovery following severe head injury assess with serial multimodality evoked potentials. J Neurosurg 1982; 57: 168–177.CrossRefGoogle ScholarPubMed
7.Moulton, R, Kresta, P, Ramirez, M, Tucker, W. Continuous automated monitoring of somatosensory evoked potentials in posttraumatic coma. J Trauma 1991; 31: 676–685.CrossRefGoogle ScholarPubMed
8.Lindsay, KW, Carlin, J, Kennedy, I, et al. Evoked potentials in severe head injury - analysis and relation to outcome. J Neurol Neurosurg Psychiatry 1981; 44: 796–802.CrossRefGoogle ScholarPubMed
9.Madl, C, Grimm, G, Kramer, L, et al. Early prediction of individual outcome after cardiopulmonary resuscitation. Lancet 1993; 341: 855–858.CrossRefGoogle ScholarPubMed
10.Kety, SS, Schmidt, CF. The determination of cerebral blood flow in man by the use of nitrous oxide in low concentrations. Am J Physiol 1945: 143: 53–66.CrossRefGoogle Scholar
11.Moulton, RJ, Konasiewicz, SJ, O’Connor, P. A new quantitative measure for monitoring somatosensory evoked potentials. Can J Neurol Sci 1994; 21: S17-S22.CrossRefGoogle ScholarPubMed
12.Lindsay, K, Pasaoglu, A, Hirst, D, et al. Somatosensory and auditory brain stem conduction after head injury: a comparison with clinical features in prediction of outcome. Neurosurgery 1990; 26: 278–285.CrossRefGoogle ScholarPubMed
13.Konasiewicz, SJ, Moulton, RJ, Shedden, PM. Somatosensory evoked potentials and intracranial pressure in severe head injury. Can J Neurol Sci 1994; 21: 219–226.CrossRefGoogle ScholarPubMed
14.Garcia-Larrea, L, Artru, F, Bertrand, O, et al. The combined monitoring of brain stem auditory evoked potentials and intracranial pressure in coma. A study of 57 patients. J Neurol Neurosurg Psychiatry 1992; 55: 792–798.CrossRefGoogle ScholarPubMed
15.Hutchinson, DO, Frith, RW, Shaw, NA, et al. A comparison between electroencephalography and somatosensory evoked potentials for outcome prediction following severe head injury. Electroencephalogr Clin Neurophysiol 1991; 78: 228–233.CrossRefGoogle ScholarPubMed