The Experts below are selected from a list of 282 Experts worldwide ranked by ideXlab platform
Donald L. Gilbert - One of the best experts on this subject based on the ideXlab platform.
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Effects of Sleep Deprivation on the Pediatric Electroencephalogram
Pediatrics, 2009Co-Authors: Steven T. Deroos, Kipp L. Chillag, Martina Keeler, Donald L. GilbertAbstract:BACKGROUND The routine Electroencephalogram aids in epilepsy syndrome diagnosis. Unfortunately, routine outpatient Electroencephalogram results are normal in roughly half of children with epilepsy. To increase the yield, practice guidelines recommend Electroencephalograms with sleep and sleep deprivation. The purpose of this study was to rigorously evaluate this recommendation in children. METHODS We conducted a randomized, blinded comparison of routine Electroencephalograms versus sleep-deprived Electroencephalograms in 206 children aged 0 to 18 years. Electroencephalograms were ordered for standard indications after a neurologist's clinical assessment indicated > or =1 seizure (83%) or unclear spell (17%). The primary outcome was the proportion of normal routine Electroencephalogram results versus sleep-deprived Electroencephalogram results. Logistic regression modeling was used to assess the influence of sleep, as well as other clinical factors. RESULTS Although children with sleep-deprived Electroencephalograms had less sleep the night before (4.9 vs 7.9 hours) and more sleep during Electroencephalograms (73% vs 55%), the increase in Electroencephalogram yield was borderline significant (56% normal sleep-deprived Electroencephalogram versus 68% normal routine Electroencephalogram). Moreover, sleep during the Electroencephalogram did not increase its diagnostic yield. Sleep-deprived Electroencephalogram yield tended to be higher in children with preElectroencephalogram clinical diagnosis of seizure(s) and at older ages (>3 years). CONCLUSIONS Sleep deprivation, but not sleep during the Electroencephalogram, modestly increases the yield of the Electroencephalogram in children diagnosed with seizures by neurologists. Compared with a routine Electroencephalogram, the number needed to test with sleep-deprived Electroencephalogram to identify 1 additional child with epileptiform discharges is approximately 11.
Michel J. A. M. Van Putten - One of the best experts on this subject based on the ideXlab platform.
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Electroencephalogram predicts outcome in patients with postanoxic coma during mild therapeutic hypothermia
Critical Care Medicine, 2015Co-Authors: Marleen C Tjepkemacloostermans, Jeannette Hofmeijer, Ronald J Trof, Michiel J Blans, Albertus Beishuizen, Michel J. A. M. Van PuttenAbstract:Objective: To assess the value of Electroencephalogram for prediction of outcome of comatose patients after cardiac arrest treated with mild therapeutic hypothermia. Design: Prospective cohort study. Setting: Medical ICU. Patients: One hundred forty-two patients with postanoxic encephalopathy after cardiac arrest, who were treated with mild therapeutic hypothermia. Measurements and Main Results: Continuous Electroencephalogram was recorded during the first 5 days of ICU admission. Visual classification of Electroencephalogram patterns was performed in 5-minute epochs at 12 and 24 hours after cardiac arrest by two independent observers, blinded for patients’ conditions and outcomes. Patterns were classified as isoelectric, low voltage, epileptiform, burst-suppression, diffusely slowed, or normal. Burst-suppression was subdivided into patterns with and without identical bursts. Primary outcome measure was the neurologic outcome based on each patient’s best achieved Cerebral Performance Category score within 6 months after inclusion. 67 patients (47%) had favorable outcome (Cerebral Performance Category, 1–2). In patients with favorable outcome, Electroencephalogram patterns improved within 24 hours after cardiac arrest, mostly toward diffusely slowed or normal. At 24 hours after cardiac arrest, the combined group of isoelectric, low voltage, and “burst-suppression with identical bursts” was associated with poor outcome with a sensitivity of 48% (95% CI, 35–61) and a specificity of 100% (95% CI, 94–100). At 12 hours, normal or diffusely slowed Electroencephalogram patterns were associated with good outcome with a sensitivity of 56% (95% CI, 41–70) and a specificity of 96% (95% CI, 86–100). Conclusions: Electroencephalogram allows reliable prediction of both good and poor neurologic outcome of patients with postanoxic encephalopathy treated with mild therapeutic hypothermia within 24 hours after cardiac arrest.
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Continuous electroencephalography monitoring for early prediction of neurological outcome in postanoxic patients after cardiac arrest: a prospective cohort study
Critical Care Medicine, 2012Co-Authors: M.c. Cloostermans, Fokke B. Van Meulen, C. Eertman, Harold W. Hom, Michel J. A. M. Van PuttenAbstract:Objective: To evaluate the value of continuous electroencephalography in early prognostication in patients treated with hypothermia after cardiac arrest. Design: Prospective cohort study. Setting: Medical intensive care unit. Patients: Sixty patients admitted to the intensive care unit for therapeutic hypothermia after cardiac arrest. Intervention: None. Measurements and Main Results: In all patients, continuous Electroencephalogram and daily somatosensory evoked potentials were recorded during the first 5 days of admission or until intensive care unit discharge. Neurological outcomes were based on each patient’s best achieved Cerebral Performance Category score within 6 months. Twenty-seven of 56 patients (48%) achieved good neurological outcome (Cerebral Performance Category score 1–2). At 12 hrs after resuscitation, 43% of the patients with good neurological outcome showed continuous, diffuse slow Electroencephalogram rhythms, whereas this was never observed in patients with poor outcome. The sensitivity for predicting poor neurological outcome of lowvoltage and isoelectric Electroencephalogram patterns 24 hrs after resuscitation was 40% (95% confidence interval 19%–64%) with a 100% specificity (confidence interval 86%–100%), whereas the sensitivity and specificity of absent somatosensory evoked potential responses during the first 24 hrs were 24% (confidence interval 10%–44%) and 100% (confidence interval: 87%–100%), respectively. The negative predictive value for poor outcome of low-voltage and isoelectric Electroencephalogram patterns was 68% (confidence interval 50%–81%) compared to 55% (confidence interval 40%–60%) for bilateral somatosensory evoked potential absence, both with a positive predictive value of 100% (confidence inter val 63%–100% and 59%–100% respectively). Burst-suppression patterns after 24 hrs were also associated with poor neurological outcome, but not inevitably so. Conclusions: In patients treated with hypothermia, Electroencephalogram monitoring during the first 24 hrs after resuscitation can contribute to the prediction of both good and poor neurological outcome. Continuous patterns within 12 hrs predicted good outcome. Isoelectric or low-voltage Electroencephalograms after 24 hrs predicted poor outcome with a sensitivity almost two times larger than bilateral absent somatosensory evoked potential responses. (Crit Care Med 2012; 40:2867–2875)
Steven T. Deroos - One of the best experts on this subject based on the ideXlab platform.
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Effects of Sleep Deprivation on the Pediatric Electroencephalogram
Pediatrics, 2009Co-Authors: Steven T. Deroos, Kipp L. Chillag, Martina Keeler, Donald L. GilbertAbstract:BACKGROUND The routine Electroencephalogram aids in epilepsy syndrome diagnosis. Unfortunately, routine outpatient Electroencephalogram results are normal in roughly half of children with epilepsy. To increase the yield, practice guidelines recommend Electroencephalograms with sleep and sleep deprivation. The purpose of this study was to rigorously evaluate this recommendation in children. METHODS We conducted a randomized, blinded comparison of routine Electroencephalograms versus sleep-deprived Electroencephalograms in 206 children aged 0 to 18 years. Electroencephalograms were ordered for standard indications after a neurologist's clinical assessment indicated > or =1 seizure (83%) or unclear spell (17%). The primary outcome was the proportion of normal routine Electroencephalogram results versus sleep-deprived Electroencephalogram results. Logistic regression modeling was used to assess the influence of sleep, as well as other clinical factors. RESULTS Although children with sleep-deprived Electroencephalograms had less sleep the night before (4.9 vs 7.9 hours) and more sleep during Electroencephalograms (73% vs 55%), the increase in Electroencephalogram yield was borderline significant (56% normal sleep-deprived Electroencephalogram versus 68% normal routine Electroencephalogram). Moreover, sleep during the Electroencephalogram did not increase its diagnostic yield. Sleep-deprived Electroencephalogram yield tended to be higher in children with preElectroencephalogram clinical diagnosis of seizure(s) and at older ages (>3 years). CONCLUSIONS Sleep deprivation, but not sleep during the Electroencephalogram, modestly increases the yield of the Electroencephalogram in children diagnosed with seizures by neurologists. Compared with a routine Electroencephalogram, the number needed to test with sleep-deprived Electroencephalogram to identify 1 additional child with epileptiform discharges is approximately 11.
Thomas H. Glick - One of the best experts on this subject based on the ideXlab platform.
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The Sleep-Deprived Electroencephalogram: Evidence and Practice
Archives of neurology, 2002Co-Authors: Thomas H. GlickAbstract:Background Sleep deprivation for the initial Electroencephalogram for suspected seizures is a widespread but inconsistent practice not informed by balanced evidence. Daily practice suggests that nonneurologists are confused by the meaning and value of, and indications for, "sleep" (tracing) vs "sleep deprivation" (and other alternatives). They need specific, informed guidance from general neurologists on best practices. Objectives To document illustratively the variability of neurologists' practices, the level of relevant information among nonneurologists, and the current state of published evidence; and to stimulate formulation of consensus advisories. Design and Setting I surveyed knowledge and practices of (1) nonneurologists in a community teaching hospital; (2) local and national neurologists and epileptologists; (3) Electroencephalogram laboratory protocols; and (4) textbook accounts and recommendations and the relevant journal literature. National professional organizations were contacted for advisories or guidelines. Results Most nonneurologists surveyed misunderstood "sleep" vs "sleep-deprived" Electroencephalograms and their actual protocols. They are unaware of evidence on benefits vs burdens. Neurologists' practices are inconsistent. Experts generally agree that sleep deprivation produces substantial activation of interictal epileptiform discharges beyond the activation of sleep per se. However, most published recommendations and interviewed epileptologists do not suggest sleep deprivation for the initial Electroencephalogram because of "inconvenience" (burdens) for the patient. Evidence-based or reasoned guidance is minimal, and professional societies have not issued advisories. Conclusion Confusion over sleep deprivation, disparities between evidence and recommendations, and inconsistent practices create a need for expert consensus for guidance, as well as comparative research on alternative methods of increasing diagnostic yield.
Martina Keeler - One of the best experts on this subject based on the ideXlab platform.
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Effects of Sleep Deprivation on the Pediatric Electroencephalogram
Pediatrics, 2009Co-Authors: Steven T. Deroos, Kipp L. Chillag, Martina Keeler, Donald L. GilbertAbstract:BACKGROUND The routine Electroencephalogram aids in epilepsy syndrome diagnosis. Unfortunately, routine outpatient Electroencephalogram results are normal in roughly half of children with epilepsy. To increase the yield, practice guidelines recommend Electroencephalograms with sleep and sleep deprivation. The purpose of this study was to rigorously evaluate this recommendation in children. METHODS We conducted a randomized, blinded comparison of routine Electroencephalograms versus sleep-deprived Electroencephalograms in 206 children aged 0 to 18 years. Electroencephalograms were ordered for standard indications after a neurologist's clinical assessment indicated > or =1 seizure (83%) or unclear spell (17%). The primary outcome was the proportion of normal routine Electroencephalogram results versus sleep-deprived Electroencephalogram results. Logistic regression modeling was used to assess the influence of sleep, as well as other clinical factors. RESULTS Although children with sleep-deprived Electroencephalograms had less sleep the night before (4.9 vs 7.9 hours) and more sleep during Electroencephalograms (73% vs 55%), the increase in Electroencephalogram yield was borderline significant (56% normal sleep-deprived Electroencephalogram versus 68% normal routine Electroencephalogram). Moreover, sleep during the Electroencephalogram did not increase its diagnostic yield. Sleep-deprived Electroencephalogram yield tended to be higher in children with preElectroencephalogram clinical diagnosis of seizure(s) and at older ages (>3 years). CONCLUSIONS Sleep deprivation, but not sleep during the Electroencephalogram, modestly increases the yield of the Electroencephalogram in children diagnosed with seizures by neurologists. Compared with a routine Electroencephalogram, the number needed to test with sleep-deprived Electroencephalogram to identify 1 additional child with epileptiform discharges is approximately 11.
