W. Xu
Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences – Beijing, China
Objective: We aim to investigate the feasibility of real-time TCD-EEG monitoring in patients with paroxysmal neurological diseases.
Design and Methods: This is an on-going single-center observational study. Six hours Real-time TCD-EEG (Delica NSD-8100) is performed in pre-surgical patients with refractory epilepsy and pre-surgical patients with Moyamoya disease and transient ischemic attacks. The TCD-EEG monitoring includes 10-20 system 16 channels EEG and bilateral middle cerebral artery blood flow velocity (CBFV) monitoring. To further investigate TCD value in the localization of epileptogenic focus, SPECT is performed, if available, in patients with seizure attacks for comparative analysis. To induce transient ischemic attacks, 3 minutes hyperventilation is performed in patients with Moyamoya disease.
In patients with seizure attacks, we observe: 1) the synchronicity between CBFV changes and epileptic discharges;2) the consistency between CBFV changes and SPECT findings; 3) the relationship between CBFV changes and epileptogenic focus as defined by EEG and SPECT;4) the correlation between TCD-EEG findings and prognosis after operation. In patients with Moaymoya disease, we observe: 1)the EEG and CBFV changes during hyperventilation; 2) the synchronicity between clinical symptoms and TCD-EEG findings;3) the correlation between TCD-EEG findings and prognosis after operation. We expect to enroll 60 patients for each group in one year (2013-2014).
Results: Three patients with epilepsy and six patients with Moyamoya disease have been enrolled for a pilot study. CBFV ipsilateral to epileptic discharges increased by 40% in two patients with epilepsy which lagged behind EEG discharges for seconds. The CBFV curve was not available for analysis in one patient due to artifacts during seizure attacks. TCD-EEG showed heterogeneous changes in patients Moayamoya disease during hyperventilation.
Conclusion: Although the technique of TCD-EEG monitoring requires modifications, it has showed promising value in patients with paroxysmal neurological diseases.
Key words: monitoring, paroxysmal neurological diseases, TCD-EEG.