Clinical Observation On Prognostic Prediction Of Continuous Electroencephalogram And Stimulation Therapy Of The Photic And Acoustic Stimulation Of Alpha Rhythm On Improving The Level Of Consciousness In Comatose Patients

Coma is a very common critically illness with complex condition and poor prognosis. Many studies are focusing on how to evaluate the prognosis of coma correctly and improve the level of consciousness. The object of our study is to investigate the background activity, reactivity and sleep spindle of CEEG on comatose patients under CEEG's monitoring furtherly. Then we put forward a new standard about the EEG grading on prognostic prediction of comatose patients. Furthermore, we explored the treatment effect of the photic and acoustic stimulation of alpha rhythm in comatose patients under CEEG's monitoring. Part One Clinical study on prognostic prediction of continuous electroencephalogram in comatose patientsObejectiveWe investigate the value of prognostic prediction of CEEG in comatose patients and explore a new simple and practical EEG standard about prognostic prediction. Meanwhile, we compared it with Synek EEG standard.ObjectThe patients were enrolled accorded with the following between May, 2008 and May, 2009 in NICU of our department, the Xijing hospital affiliated to The Fourth Military University: 1.during the initial 24 hours to two weeks after the onset of disease (a. state of the illness was stable; b.according with the international diagnostic standard about the acute conscious disturbance). 2.GCS≤8. 3.The family members of the patients were informed and consent.Excluding criterion: 1. The drug which influencing brain function had been used recently(such as Phenobarbital and narcotics); 2. the patients needed breath support and had much disturbance to EEG signal. 3. the cases with the history of severe visual,hearing and limb movement disorders.Sixty-eight comatose patients were accorded with the criteria (37 men and 31 women; median age, 53.5±12.6 years; range, 15-84 years). The mean GCS was(6.05±1.74).Methods1. Sixty-eight patients were mornitored by CEEG with the standard electrode setting of the International Federation for Electroencephalogy and Clinical Neurophysiol, ten-twenty electrode system, 16 channel amplifier. The recording time was more than 16 hours. We used the SOLAR 2000 Nervous Central Monitoring System produced by Solar Electronic Technologies Co. Ltd in Beijing. After the skin were defated, we fixed the electrode on the scalp with pyroxylin. The velocity is 3cm/s, low frequency filter is 0.5HZ, high frequency filter is 70HZ.2. We mornitored the background activity, reactivity and sleep spindle of CEEG,.then analysed their correlation with prognosis respectively.3. The CEEG of all cases were analysed accorded with EEG grading of Synek. Then we analysed their correlation with prognosis.4. Recombining the reactivity and sleep spindle of CEEG, we introduce the standard of EEG coma.5. The prognosis of patients were observed according to GOS 30 days after the onset of coma. Based on GOS, the patients were divided into a poor-outcome group (GOS, 1-2) and satisfactory-outcome group (GOS, 3-5).6. The analyses were completed by statistical software package type SPSS 12.0 with chi-square test,spearma correlation analysis and Logistic Regression analysis. Statistical results with P<0.05 had significant difference.7. Two different EEG standards(Synek and EEG coma)were analysed and compared about the sensibility,specificity and veracity on prognostic prediction.Results1. The background activity(volatility,waveform and frequency) can be used to estimate the prognosis dynamically.2. The reactivity and sleep spindle of EEG is related with the prognosis in comatose patients (P <0.05).3. The correlation coefficient of r between Synek grading and prognosis in comatose patients is 0.40,P<0.01. The sensibility,specificity and veracity of prognostic prediction of Synek standard is 73%,83% and 79% respectively. 4. The correlation coefficient of r between EEG coma grading and prognosis is 0.42, P<0.01. The sensibility, specificity and veracity of prognostic prediction of EEG coma standard is 63%,100%,and 78% respectively.Conclusions1. CEEG can be used to assess the prognosis of coma correctly and objectively.2. The background activity(volatility,waveform and frequency),reactivity and sleep spindle of CEEG can be used as very important reference to estimate the prognosis.3. Two standards are similar on the veracity of prognostic prediction.4. The specificity of prognostic prediction of EEG coma standard is higher,but the sensibility is lower. It can provide reference to clinical judgment.Part two Clinical observation about the photic and acoustic stimulation therapy of alpha rhythm on improving the level of consciousness of comatose patients under CEEG monitoringObejectiveWe observe the therapeutic effect and safety of the photic and acoustic stimulation of alpha rhythm on improving the level of consciousness of comatose patients under CEEG monitoring.Object1. The cases were enrolled according with the following standard between May, 2009 and February, 2010 in NICU of our department, the Xijing hospital affiliated to The Fourth Military University: 1.during the initial 24 hours to two weeks after the onset of disease(a.the state of the illness was stable; b.according with the international standard about the acute conscious disturbance; 2. GCS≤8; 3.The family members of patients were informed and consent. Excluding criterion:1.The cases that had a previous history of epilepsy; 2. The drug which influencing brain function had been used recently(such as Phenobarbital and narcotics); 3. the patients needed breath support; 4. the cases with the history of severe visual, hearing and limb movement disorders; 5. the cases who needed the surgerical treatment. 6. the cases with previous history of serious chronic diseases such as hypertension, coronary heart disease and pulmonary tuberculosis; 7. pregnant or lactating women; 8. the cases with previous history of mental disorders.Twenty-four severe brain disease cases had been included in our experiment, of which six cases were carbon monoxide poisoning, five cases were post-cardiopulmonary resuscitation(CPR), four cases were intracerebral hemorrhage because of hypertension, four cases were large area cerebral infarction. The patients are 19-75 years old,the mean age was 43.5(SD 12.2)years. The mean GCS was(5.95±1.72).Methods1. Among twenty-four cases, two were excluded because of the epileptic discharges during CEEG monitoring before stimulattion. Besides routine therapy the twenty-two cases had been treated with the photic and acoustic stimulation of alpha rhythm, twice everyday, 30 minutes each time, lasting two weeks. We monitored ninety minutes during the treatment.2. We used the SOLAR 2000 Nervous Central Monitoring System produced by Solar Electronic Technologies Co. Ltd in Beijing. We mornitored the cases by CEEG with the standard electrode setting of the International Federation for Electroencephalogy and Clinical Neurophysiol, ten-twenty electrode system, 16 channel amplifier.3. The photic and acoustic stimulation system of alpha rhythm is the product of Amercian SYNETICSYSTEMS corporation. Using headphone and spark glasses, the frequency is 8-13Hz, the brightness of vision stimulating is 10-100Nits/f, the loundness of hearing is 20-150db(nHL).4. The GCS score scale was observed before treatment, three days, six days, nine days and fourteen days after treatment respectively.5. The prognosis of patients were observed according to GCS and GOS 30 days after the onset of coma. Based on GOS and GCS, the cases were divided into a recovery group and better group.6. The analyses were completed by statistical software package type SPSS 12.0 with T test and chi-square test. Statistical results with P<0.05 had significant difference.Results1. CEEG monitoring:(1) The CEEG monitoring didn't show any epileptic discharges in all patients treated with acoustic stimulation therapy of alpha rhythm.(2) There were three patients whose CEEG monitoring showed the changes of volatility and frequence at the start of treatment. At the 14th day of treatment, seven patients whose CEEG monitoring showed the changes of volatility and frequence at the start of treatment.(3) There was one patient whose CEEG monitoring showed regular alpha rhythm, and two patients whose CEEG monitoring showed regular thelta rhythm during in harmony with the stimulation.2. The average GCS of all cases had inceased gradually during the treatment. 3. Prognosis(1) Thirteen cases'consciousness had been recovery. Sixteen cases had been better after treatment.(2) At the 14th day of treatment, there were seven patients whose CEEG showed the changes of volatility and frequence at the start of stimulation, of which five patients had been recovery and six patients had been better.(3) Three cases whose CEEG showed regular alpha or thelta rhythm in harmony with the stimulation had been recovery.Conclusions1. The photic and acoustic stimulation of alpha rhythm is relatively safe to improve the level of consciousness of comatose cases in this study.2. The synchronous monitoring of CEEG is a means to monitor the effect of treatment and certify the safety furtherly.