RESUMEN
Continuous EEG monitoring is considered to be a sensitive indicator of changes in cerebral function. This paper describes a system for cotside display and analysis of EEG discontinuity and amplitude in one-minute epochs, with provision for simultaneous recording of the EEG. It has been successfully used to monitor continuously the EEGs of more than 30 babies in a neonatal intensive care unit for periods of up to nine days. This system rapidly provides indications of changes in cerebral function, which can allow early intervention and possible prevention of morbidity.
Asunto(s)
Daño Encefálico Crónico/diagnóstico , Daño Encefálico Crónico/fisiopatología , Electroencefalografía/instrumentación , Monitoreo Fetal/instrumentación , Microcomputadores , Procesamiento de Señales Asistido por Computador/instrumentación , Dominancia Cerebral/fisiología , Potenciales Evocados/fisiología , Femenino , Edad Gestacional , Humanos , Recién Nacido , Sistemas en Línea/instrumentación , Embarazo , Programas InformáticosRESUMEN
Twenty infants, diagnosed by cranial ultrasound as having extensive cystic leukomalacia, had visual evoked responses (VER) and electroencephalograms (EEG) in the neonatal period and MRI scans later in infancy. The early ultrasound findings and results from the electrophysiological tests were correlated with later MRI findings and functional abilities. In infants with periventricular leukomalacia (PVL), the cysts were usually no longer visible by ultrasonography, beyond 40 weeks postmenstrual age (PMA), but later MRI scans showed a consistent pattern of delayed myelination around the irregularly dilated occipital horns of the lateral ventricles. VER's were present in the neonatal period and vision was maintained, although all infants developed a marked squint. EEG's were either normal or abnormal initially, but improvement was noted within several weeks. In those with subcortical or mixed lesions, cysts were noted to persist beyond 40 weeks PMA. Later MRI scans showed very poor myelination, with poor progress on subsequent scans and cortical atrophy. VER's were absent and all infants later became cortically blind. EEG's were severely abnormal and recovery was very poor. The infants with PVL developed spastic diplegia with moderate developmental delay, while those with mixed or subcortical lesions developed quadriplegia with severe mental retardation. An integrated approach, consisting of ultrasound imaging and electrophysiological recordings in the neonatal period and MRI imaging later in infancy, may provide a more reliable prediction of the pattern of later deficits.
Asunto(s)
Quistes/diagnóstico , Encefalomalacia/diagnóstico , Potenciales Evocados Visuales , Leucomalacia Periventricular/diagnóstico , Espectroscopía de Resonancia Magnética , Examen Neurológico , Encéfalo/patología , Quistes/patología , Ecoencefalografía , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Leucomalacia Periventricular/patologíaRESUMEN
Clinical diagnosis of neonatal seizure is difficult and repeated seizures may be unrecognised. To assist in early diagnosis we recorded continuously the electroencephalogram (EEG) of very sick newborns while intensive care continued. In 25 babies at high risk of seizure a continuous record of two channels of EEG, ECG, and respiration was made for periods varying from 11 hours to 16 days. The method employed produced an EEG largely free of movement and electrical artefact which was analysed rapidly using a visual display unit. Electroencephalographic seizure activity was recorded in 20 babies, and continuous monitoring of the EEG allowed earlier recognition of seizure than was possible with clinical observation.