Skip to main content
SpringerLink
Log in

Multimodal monitoring to aid detection and management of intraoperative seizures: a case report

  • Letter to the Editor
  • Published:
Journal of Clinical Monitoring and Computing Aims and scope Submit manuscript

Abstract

One of the primary goals in Neuroanesthesia is to preserve cerebral oxygenation and protect the brain from secondary injuries. Seizures have severe implications in the intraoperative period, as it can instigate an increase in cerebral metabolism and oxygen demand, thus causing cerebral hypoxia. Detection of intraoperative seizures is imperative in neurosurgical cases as the ramifications of intracranial hypertension and cerebral hypoxia caused by it can affect patient prognosis and perioperative outcomes. We report a case of detecting intraoperative seizures with the aid of patient state index and near infrared spectroscopy. Multi-modality monitoring aided in the management of a time-sensitive complication, which could otherwise have possibly led to secondary brain insult.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

References

  1. Kutteruf R, Yang JT, Hecker JG, Kinney GA, Furman MA, Sharma D. Incidence and risk factors for intraoperative seizures during elective craniotomy. J Neurosurg Anesthesiol. 2019;31:234–40.

    Article  Google Scholar 

  2. Howe J, Lu X, Thompson Z, Peterson GW, Losey TE. Intraoperative seizures during craniotomy under general anesthesia. Seizure. 2016;38:23–5.

    Article  Google Scholar 

  3. Soehle M, Ellerkmann RK, Grube M, Kuech M, Wirz S, Hoeft A. Comparison between bispectral index and patient state index as measures of the electroencephalographic effects of sevoflurane. Anesthesiology. 2008;109(5):799–805.

    Article  Google Scholar 

  4. Kim SY, Kim H. Pitfall of bispectral index during intraoperative seizure -a case report. Korean J Anesthesiol. 2013;65(5):449–52.

    Article  Google Scholar 

  5. Chinzei M, Sawamura S, Hayashida M, Kitamura T, Tamai H, Hanaoka K. Change in bispectral index during epileptiform electrical activity under sevoflurane anesthesia in a patient with epilepsy. Anesth Analg. 2004;98:1734–6.

    Article  Google Scholar 

  6. Tallach RE, Ball DR, Jefferson P. Monitoring seizures with the bispectral index. Anaesthesia. 2004;59:1033–4.

    Article  CAS  Google Scholar 

  7. Ntahe A. Early diagnosis of nonconvulsive status epilepticus recurrence with raw EEG of a bispectral index monitor. Case Rep Crit Care. 2018. https://doi.org/10.1155/2018/1208401.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Sahinovic MM, Beese U, Heeremans EH, Kalmar A, van Amsterdam K, Steenbakkers RJ, et al. Bispectral index values and propofol concentrations at loss and return of consciousness in patients with frontal brain tumours and control patients. Br J Anaesth. 2014;112(1):110–7.

    Article  CAS  Google Scholar 

  9. Scheeren TW, Schober P, Schwarte LA. Monitoring tissue oxygenation by near infrared spectroscopy (NIRS): background and current applications. J Clin Monit Comput. 2012;26:279–87.

    Article  CAS  Google Scholar 

  10. Ajayan N, Thakkar KD, Lionel KR, Hrishi AP. Limitations of near infrared spectroscopy (NIRS) in neurosurgical setting: our case experience. J Clin Monit Comput. 2019;33(4):743–6.

    Article  Google Scholar 

  11. Nguyen DK, Tremblay J, Pouliot P, Vannasing P, Florea O, Carmant L. Non-invasive continuous EEG-fNIRS recording of temporal lobe seizures. Epilepsy Res. 2012;99(1–2):112–26.

    Article  Google Scholar 

  12. Sokol DK, Markand ON, Daly EC, Leurssen TG, Malkoff MD. Near infrared spectroscopy (NIRS) distinguishes seizure types. Seizure. 2000;9(5):323–7.

    Article  CAS  Google Scholar 

  13. Jeppesen J, Beniczky S, Johansen P, Sidenius P, Fuglsang-Frederiksen A. Exploring the capability of wireless near infrared spectroscopy as a portable seizure detection device for epilepsy patients. Seizure. 2015;26:43–8.

    Article  Google Scholar 

Download references

Acknowledgements

We want to acknowledge Dr. Gayatri Devi Nair MD, Transplant Nephrologist, Northshore University Hospital, 300 Community Drive, Manhasset, NY11030 for editing the manuscript, and for her valuable suggestions.

Funding

Nil.

Author information

Authors and Affiliations

  1. Neuroanesthesia Division, Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India

    Neeraja Ajayan, Ajay Prasad Hrishi & Unnikrishnan Prathapadas

Authors
  1. Neeraja Ajayan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ajay Prasad Hrishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Unnikrishnan Prathapadas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ajay Prasad Hrishi.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Research involving human and animal rights

All procedures performed in this case report involving the human participant were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from the individual participants included in the study. None of individual participants identifying information is included in this article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ajayan, N., Hrishi, A.P. & Prathapadas, U. Multimodal monitoring to aid detection and management of intraoperative seizures: a case report. J Clin Monit Comput 35, 209–212 (2021). https://doi.org/10.1007/s10877-020-00461-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10877-020-00461-7

Keywords

Search

Navigation