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PREDICTING ALERTNESS WITH EEG PROCESSING IN A PATIENT UNDERG= OING
DEEP BRAIN STIMULATOR PLACEMENT FOR PARKINSONS DISEASE <= /b>
Andrew Alshab, MD, MPH= <= b>, Thomas Collura, PhD, Donald M. Voltz, MD
University Hospitals of Cleveland and Case Western Reser= ve University, Cleveland, Ohio
=
=
INTRODUCTION <= /u>
<= u>
This paper presents electroencephalographic (EEG) processing with BrainMaster® Technology in a patient undergoing deep= brain stimulator (DBS) for the treatment of Parkinson's disease. With advanced progression of the disease and the potential for surgical injury during placement of the electrodes, it is important to be able to reliably predict patient emergence from anesthesia to allow for an accurate and complete neuro-cognitive examination. We were able to demonstrate changes in EEG amplitudes and coherence that track changes in the conscious state as anesthetics were administered and withdrawn during DBS placement.
METHODS
The patients scheduled to undergo the placement of electrodes in the subthalamic area for advanced Parkinson’s disease received an anesthetic consisting of midazolam, fentan= yl, and propofol titrated to achieve comfort and safety during periods of surg= ical stimulation. Following stereotactic placement of the DBS, the patients eme= rged from anesthesia to a level commensurate with neuro-cognitive testing. EEG = was recorded from O1 and from O2 providing an assessment of temporal and occip= ital activity. The software yielded real-time visual output of hemispheric concordance. Short-term fluctuation was evident, as well as dramatic chang= es indicating the change from anesthetized to the aroused state. In this case= , we observed increase in beta-range coherence as the patient regained consciousness. This correlated well with the patient’s ability to cooperate with the neuro-cognitive testing. The patients underwent the placement of a DBS on the contralateral side following completion of the first (fig 1).&#= 13;
RESULTS
It is often difficu= lt to follow the regression of anesthetics to allow for reliable completion of neuro-cog= nitive testing in patients undergoing DBS placement. The ability to follow coherence that correlates with altering levels of consciousness was helpful in these cases. As can be appreciated from the figure, the placement of the second electrode, many hours from the start of surgery, required more time for the anesthetics to be metabolized or redistributed, allowing for emergence; not at all unexpected due to the total amounts of medications administered by this time.
Similar results have been reported recently1,2<= span style=3D'font-family:Arial;font-size:92%'>. Both reports indicate that short-term changes in EEG coherence were observed in response to anesthetic administration As well as emergence. Our observations are consistent with these reports, and indicate that real-time monitoring of this type of metr= ic has potential value for intraoperative management.
CONCLUSION
In this small case series, there was a correlation between EEG β-coherence and a patients ability to participate in neurocognitive testing, a requirement to insure = the correct placement of the DBS. The ability to titrate anesthetics and measure their physiologic degradation using real-time EEG processing might prove useful information = for assessing individual anesthetic variability. Translation of this monitoring modality to other anesthetic cases requires further investigation.
REFERENCES
=
John, E.R., et a= l. (2005) Changes in Gamma Coherence at Loss and Return of Consciousness = during Anesthesia with Various Agents, ASA Annual Meeting, New Orleans, LA, A-281
=
Lo, S.S., et al. (2005) Inhalational Anesthetic Effects on EEG Coherence in Infants and Children, American Academy of Pediatrics Society for Pediatric Anesthesia 2005 Meeting, Miami Beach, FL. 20P106. =
Figure 1: Representative case demonstrating β-Coherence of EEG signal correla= ting well with patient ability to accurately cooperate with neurocognitive test= ing during deep brain stimulator placement for Parkinson's disease.
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