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J Neurocrit Care 2012;5(1): 1-7.
신경계집중치료실에서의 지속적 뇌파 검사
김 지 현
고려대학교 의과대학 신경과학교실
Continuous Electroencephalogram Monitoring in the Neuro-Intensive Care Unit
Ji Hyun Kim, MD, PhD
Department of Neurology, Korea University College of Medicine, Seoul, Korea
ABSTRACT
With the advent of recent technical advances, it is now plausible to record and monitor the continuous digital electroencephalogram (EEG) of many critically ill patients simultaneously. Continuous EEG monitoring (CEEG) provides dynamic information about brain function that permits early detection of changes in neurological state, which is especially useful when the detailed neurological examination is limited. Nonconvulsive seizures are common in comatose critically ill patients and can have multiple negative impacts on the injured brain. The majority of seizures in these patients cannot be detected without simultaneous CEEG. CEEG monitoring is most commonly used to detect and guide treatment of nonconvulsive seizures. In addition, CEEG is useful in management of pharmacological coma for treatment of increased intracranial pressure and intractable status epilepticus. An emerging application for CEEG is to detect new or worsening brain ischemia in patients at high risk, especially those with subarachnoid hemorrhage. Improving quantitative EEG software is helping to make it feasible for CEEG to provide continuous information regarding changes in brain function in real time at the bedside and to prompt clinicians to detect acute brain insults, including seizures, ischemia, increasing intracranial pressure, hemorrhage, and even systemic abnormalities affecting the brain, such as hypoxia, hypotension, acidosis, and others. CEEG with only a few scalp electrodes or CEEG without expert review of the raw EEG must be interpreted with extreme caution because false positives and false negatives are quite common. When CEEG is combined with individualized, physiologically driven decision making via multimodality brain monitoring, neurologists can identify when the brain is at risk for injury or when neuronal injury is already occurring. The exact role and cost-effectiveness of CEEG at the current time remains unclear, but it has important potential to improve neurologic outcomes in a variety of neurologically abnormal conditions.
Key Words: Continuous EEG monitoring · Nonconvulsive seizures · Intensive care unit
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