Neurological injury, such as from cerebral hypoxia, appears to cause complex changes in the shape of evoked potential (EP) signals. To characterize such changes we analyze EP signals with the aid of scaling functions called wavelets. In particular, we consider multiresolution wavelets that are a family of orthonormal functions. In the time domain, the multiresolution wavelets analyze EP signals at coarse or successively greater levels of temporal detail. In the frequency domain, the multiresolution wavelets resolve the EP signal into independent spectral bands. In an experimental demonstration of the method, somatosensory EP signals recorded during cerebral hypoxia in anesthetized cats are analyzed. Results obtained by multiresolution wavelet analysis are compared with conventional time-domain analysis and Fourier series expansions of the same signals. Multiresolution wavelet analysis appears to be a different, sensitive way to analyze EP signal features and to follow the EP signal trends in neurologic injury. Two characteristics appear to be of diagnostic value: the detail component of the MRW displays an early and a more rapid decline in response to hypoxic injury while the coarse component displays an earlier recovery upon reoxygenation. >

Multiresolution wavelet analysis of evoked potentials

By studying neuronal activity through neuronal electrogenesis, neurophysiological investigations provide a functional assessment of the nervous system and, therefore, has been used for quantitative assessment and follow-up of hepatic encephalopathy (HE). The different clinical neurophysiological approaches can be classified depending on the function to explore and their sensitivity to HE. The reliable techniques are those that reflect cortical function, i.e., cognitive-evoked potentials (EPs) (P300 paradigm), electroencephalogram (EEG), visual EPs (latency>100 ms) and somatosensory EPs (SEPs) (latency between 25 and 100 ms). Short-latency EPs (brainstem acoustic EPs, SEPs of a latency<25 ms) are in principle insensitive to HE, but can disclose brainstem conduction deficits due to oedema. SEPs and motor EPs can disclose myelopathies. Because of its parallelism to the clinical examination, clinical neurophysiology can complement the neurological examination: (i) to provide evidence of HE in patients who have normal consciousness; (ii) to rule out, at least under some conditions, disturbances of consciousness due to other causes (e.g. drug-induced disturbances, non-convulsive status epilepticus) with the reservation that the mildest degrees of encephalopathy might be associated with an EEG pattern similar to that induced by drugs; and (iii) to demonstrate the worsening or, conversely improvement, of HE in the follow-up period.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1478-3231.2009.02030.x

Neurophysiological investigations of hepatic encephalopathy: ISHEN practice guidelines.

Summary Study aim To provide a consensus of European leading authorities about the optimal use of clinical neurophysiological (CN) tests (electroencephalogram [EEG]; evoked potentials [EP]; electroneuromyography [ENMG]) in the intensive care unit (ICU) and, particularly, about the way to make these tests clinically useful for the management of individual patients. Methods This study gathered together several European clinical neurophysiologists and neurointensivists whose leading contributions in the adult or paediatric ICU and in continuous neuromonitoring had been peer-acknowledged. It was based on both a literature review and each participant's own experience. Given the methodological impossibility to gather studies fulfilling criteria of evidence-based medicine, this article essentially relies on expert opinions that were gained after several rounds, in which each expert was invited to communicate his own contribution to all other experts. A complete consensus has been reached when submitting the manuscript. Results What the group considered as the best classification systems for EEG and EP abnormalities in the ICU is first presented. CN tests are useful for diagnosis (epilepsy, brain death, and neuromuscular disorders), prognosis (anoxic ischemic encephalopathy, head trauma, and neurologic disturbances of metabolic and toxic origin), and follow-up, in the adult, paediatric, and neonatal ICU. Regarding prognosis, a clear distinction is made between these tests whose abnormalities are indicative of an ominous prognosis and those whose relative normalcy is indicative of a good prognosis. The prognostic significance of any test may vary as a function of coma etiology. Conclusion CN provides quantitative functional assessment of the nervous system. It can be used in sedated or curarized patients. Therefore, it should play a major role in the individual assessment of ICU patients.

Consensus on the use of neurophysiological tests in the intensive care unit (ICU): electroencephalogram (EEG), evoked potentials (EP), and electroneuromyography (ENMG).

Consensus on the use of neurophysiological tests in the intensive care unit (ICU): Electroencephalogram (EEG), evoked potentials (EP), and electroneuromyography (ENMG) Consensus sur l'utilisation des essais neurophysiologiques dans l'unité de soins intensifs (USI) : électroencéphalogramme (EEG), potentiels évoqués (PE) et électroneuromyographie (ENMG)

IFCN recommended standards for electrophysiologic monitoring in comatose and other unresponsive states. Report of an IFCN committee.

Individual monitoring of EEG and evoked potentials is gradually becoming standard in neurosurgery: compressed power spectra during carotid endarterectomy, brainstem auditory evoked potentials (BAEP) during posterior fossa surgery, and somatosensory evoked potentials (SEP) mainly during spinal cord surgery. In this paper, a new technique is described in which EEG, BAEP, and SEP are recorded and evaluated simultaneously and continuously. This allows a better survey of different neuronal structures and systems in the brain and brainstem. First results from intraoperative and intensive care patient monitoring are reported.

Continuous and simultaneous monitoring of EEG spectra and brainstem auditory and somatosensory evoked potentials in the intensive care unit and the operating room.

L. Auer

Papers

Continuous and simultaneous monitoring of EEG spectra and brainstem auditory and somatosensory evoked potentials in the intensive care unit and the operating room.

Compressed EP and EEG spectra monitoring in the intensive care unit and operating theatre