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Hemodynamic Changes Associated with Lateralized Periodic Discharges: A Near-Infrared Spectroscopy and Continuous EEG Study

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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 SO2 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.

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Acknowledgements

We thank Stanca Iacob MD, Ph. D. for useful suggestions and editing of the manuscript. This research is supported by the OSF Illinois Neurological Institute research fund, Spring 2017.

Funding

This project was completed with funding from the OSF Healthcare Illinois Neurological Institute research fund.

Author information

Authors and Affiliations

  1. Department of Neurology, OSF Illinois Neurological Institute, 200 E Pennsylvania Ave, Peoria, IL, 61603, USA

    Erhan Ergene & Michael Xu

  2. Department of Neurosurgery, OSF Illinois Neurological Institute, 200 E Pennsylvania Ave, Peoria, IL, 61603, USA

    Nolan Winslow

  3. Health Care Engineering Systems Center, University of Illinois Urbana-Champaign, 1206 W. Clark Street, Urbana, IL, 61801, USA

    Antonios Michalos

  4. University of Illinois College of Medicine, One Illini Drive, Peoria, IL, 61656, USA

    Huaping Wang

  5. Department of Engineering, University of Illinois Urbana-Champaign, 1206 W. Clark Street, Urbana, IL, 61801, USA

    Mebin George

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  1. Nolan Winslow
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Contributions

MX, principal investigator, designed and conceptualized study, analyzed and interpreted EEG and NIRS data, participated in drafting, and edited manuscript. NW, co-investigator, participated in designing and conceptualizing study, collected/analyzed EEG and NIRS data, and drafted manuscript. AM, co-investigator, provided equipment and advice on NIRS data, and edited manuscript. EE, co-investigator, analyzed and interpreted EEG, and edited manuscript. MG, co-investigator, provides technical guidance on NIRS recording. HW, co-investigator, performed statistical analysis.

Corresponding author

Correspondence to Michael Xu.

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Conflict of interest

The authors have no financial, consultant, or institutional conflicts of interest related to this study to declare.

Ethical Approval

This study was approved by the University of Illinois College of Medicine at Peoria IRB, Peoria IL. The manuscript complies with all instruction to authors and was approved all authors. It has not been published elsewhere ad is not under consideration by another journal.

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Winslow, N., George, M., Michalos, A. et al. Hemodynamic Changes Associated with Lateralized Periodic Discharges: A Near-Infrared Spectroscopy and Continuous EEG Study. Neurocrit Care 35, 153–161 (2021). https://doi.org/10.1007/s12028-020-01154-4

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  • DOI: https://doi.org/10.1007/s12028-020-01154-4

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