TBI or Sports Brain Injuries-Diagnosis without Opening the Skull?

My Editorial and Review on Recent Trends in Brain Damage is next, in the mean time, this is the latest news about Traumatic Brain Injruy (TBI) and how Spreading Depolarization can be tapped using neuromonitoring and how that can be used to understand and interpret the brain damage without opening the skull, what I meant is without a neurosurgery?.

EEG technique and Treatment of Rolandic Epilepsy treatment?.

Looking at the EEG patterns periodically at certain time difference, could be week or month in between, Yamanashi and his colleague found that there is a repetitive high frequency EEG waveform abnormality that can be used to strategies for treatment?. Although, it is a brief study on small number of children's, EEG recordings and the abnormal waveform morphology is one of the or the only way to ascertain what to do with such epileptic patient, actually, while referring to the recent reviews in this field, I found this compelling review article   by Dr.Markand, MD (see at the bottom after the Yamanashi's work).

What was their research model and study is about:

A total of ten children between the ages of three and ten with recurrent seizures and 12 patients aged between four and seven years who experienced isolated seizures were enrolled in the study, with seizure recurrence and prolonged high-frequency EEG paroxysm data being correlated by the scientists.
Repeated EEG recordings were taken every three months, with clinical and EEG follow-up performed for four or more years. It was discovered that seizure recurrence and extended periods of high-frequency paroxysmal EEG abnormalities for more than 6 months after onset were significantly linked.

New study shows how EEG can aid rolandic epilepsy treatment

Posted May 21 2014 in epilepsy in children and its treatment

A new study from Japan has shed light on how electroencephalogram (EEG) techniques can be useful in aiding the treatment of patients with rolandic epilepsy.

This form of epilepsy is generally associated with favourable outcomes, with a moderate proportion of cases characterised by isolated seizure events, meaning continuous treatment need only be considered only for those affected by frequent seizures.

As such, the new research from the University of Yamanashi aimed to identify EEG criteria related to seizure recurrence in rolandic epilepsy, in order to help guide treatment strategies for those in this patient group.


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The review article that I mentioned above:

a good read to get the background idea of how the neurophysiologist, neurologist or clinicians can discern the EEG patterns:

Seminars in Neurology

Pearls, Perils, and Pitfalls In the Use of the Electroencephalogram

Omkar N. Markand, MD, FRCPC

 An EEG is the most common and most useful test performed in evaluating patients suspected of epilepsy. There are many areas where an EEG has unique contributions. The value of an EEG lies in the fact that it not only shows specific ictal discharges during a clinical seizure but also characteristic epileptiform abnormalities in a high proportion of epileptic patients even in the interictal period. Furthermore, an EEG may be the only test demonstrating focal abnormalities responsible for the patient's epileptic seizures. Specific patterns in the EEG make it possible to classify the seizure type, which is an essential prerequisite to institute proper antiepileptic medication. An EEG is indispensable for the diagnosis of nonconvulsive epileptic status presenting as prolonged "twilight" state or a prolonged episode of abnormal behavior. In a patient with bizarre motor activity, the recording of an EEG during such an episode may be the only way to establish whether the abnormal behavior is due to an epileptic seizure or a nonepileptic event, physiologic or nonphysiologic. Finally, the EEG is indispensable to localize the epileptogenic (seizure producing) zone before resective surgery (excision of the epileptogenic zone) is undertaken in a patient with medically refractory focal epilepsy.

Epilepsy: Drug Resistent Focal Epilepsy & Surgical Resection treatments, two Epilepsia Reports

Brain and Spine, 2014 Research Reports:

Fig from-Link: Human Epilepsy Patterns, focal epilepsy,

The following two new research reports published in Epilepsia journal [quoted Epilepsy current]might be of interest to those Epilepsy doctors and professionals, ofcourse to Neurophysiologists and long term intraoperative monitoring field.

Quoted: Current Literature In Clinical Science
Are HFOs Still UFOs? The Known and Unknown About High Frequency Oscillations in Epilepsy Surgery

High-Frequency Oscillations, Extent of Surgical Resection, and Surgical Outcome in Drug-Resistant Focal Epilepsy.

Haegelen C, Perucca P, Chatillon CE, Andrade-Valenca L, Zelmann R, Jacobs J, Collins DL, Dubeau F, Olivier A, Gotman J.

Epilepsia 2013;54:848–857.

PURPOSE: Removal of areas generating high-frequency oscillations (HFOs) recorded from the intracerebral electroencephalography
(iEEG) of patients with medically intractable epilepsy has been found to be correlated with improved surgical outcome. However, whether differences exist according to the type of epilepsy is largely unknown. We performed a comparative assessment of the impact of removing HFO-generating tissue on surgical outcome between temporal lobe epilepsy (TLE) and extratemporal lobe epilepsy (ETLE). We also assessed the relationship between the extent of surgical resectionand surgical outcome.

Read the full abstract at: http://www.aesnet.org/files/dmfile/epcu_13.6_273_ClinicalCommentary_Jobst.pdf#!
And the Full article at Epilesia journal.

Ripple Classification Helps to Localize the Seizure-Onset Zone in Neocortical Epilepsy.

Wang S, Wang IZ, Bulacio JC, Mosher JC, Gonzalez-Martinez J, Alexopoulos AV, Najm IM, So NK.

 Epilepsia 2013;54:370–376.

PURPOSE: Fast ripples are reported to be highly localizing to the epileptogenic or seizure-onset zone (SOZ) but may not be readily found in neocortical epilepsy, whereas ripples are insufficiently localizing. Herein we classified interictal neocortical ripples by associated characteristics to identify a subtype that may help to localize the SOZ in neocortical epilepsy. We hypothesize that ripples associated with an interictal epileptiform discharge (IED) are more pathologic,since the IED is not a normal physiologic event.

For full abstract and article, refer as the previous.

How to Calculate Frequency, Duration & Amplitude in EEG?

Bill Byrum writes about how to analyse and evaluate EEG inorder to calculate the frequency, duration etc., in the following article that appeared in the latest ASET newsletter.

Calculating Frequency, Duration, Amplitude, and Voltage Using a Legend
By Bill Byrum, MBA, R. EEG/EP T., CNIM

In this article I want to review with you
how simple it is to use a Legend. You will
need a measurement ruler graduated into
one mm segments. It would also be handy
to have a calculator that can be set to divide
to 3 decimal places. If you perform division
by hand, please be sure to carry the results
to 3 decimal places when calculating
waveform duration.
I strongly recommend whenever you
are doing calculation utilizing a Legend
that you use a referential montage and the
reference is not contaminated with EEG
activity. This is because in a bipolar
montage the waveforms are the result of
two inputs active with EEG activity. The
same can be said of a referential montage if
the reference is contaminated. For complete article, click the linked title?.

Cardiovascular Surgery (like Cardiopulmanory bypass-CPB) & Neuromonitoring!

The following article demonstrates that neuromonitoring is very useful in cardiovascular surgeries, especially in patients with cerebrovascular diseases.

Intraoperative neuromonitoring in cardiac surgical patients with severe cerebrovascular disease
Alexander Kulik, MD, Rosendo A. Rodriguez, MD PhD, Howard J. Nathan, MD and Marc Ruel, MD MPH
University of Ottawa, Ottawa, Canada, E-mail: akulik@ottawaheart.ca

To the Editor:
Patients with severe cerebrovascular disease are at a high risk of neurologic complications during cardiac surgery, as a result of cerebral embolization or hypoperfusion during cardiopulmonary bypass (CPB). Intraoperative neuromonitoring, including transcranial Doppler ultrasound (TCD) and electroencephalography (EEG), may be particularly useful in patients with cerebrovascular disease.1 We hereby present two cases that illustrate the use of intraoperative neuromonitoring during cardiac surgery in patients with severe cerebrovascular disease.

Some Stats about CNIM Exam

CNIM Written Exam 2003-2006
One of the following must be met and verified for candidates

to be eligible to take the CNIM Exam:

Health care credential plus documentation of 100 cases monitored
Bachelor’s degree plus documentation of 100 cases monitored
68% passed on their first attempt. The pass rate for repeaters was 46%.
39% had another health care credential. Their pass rate was 50%.
61% of candidates had a bachelor’s degree or higher and a 61% pass rate.
Some of the candidates with bachelor’s or advanced degrees, also documented they had another health care credential.
Procedures Performed in the OR Totals
Totals Percentage
Spinal Nerve EMG 911 83%
Motor Pathway 783 71%
Intraop Scalp EEG 719 65%
BAEP 661 60%
Cranial Nerve EMG 619 56%
Cortical mapping 337 31%
ECOG 197 18%
VEP 139 13%

41% of candidates stated CNIM was a Job Requirement. This was the most common reason stated for taking the exam. The second most common response was Professional Advancement (34%) and the third reason selected was Personal Goal (18%).