Expert level of detection of interictal discharges with a deep neural network.

Objective: Deep learning methods have shown potential in automating the detection of interictal epileptiform discharges (IEDs) in electroencephalography (EEG). We compared IED detection using our previously trained deep neural network with a group of experts to assess its potential applicability.

Methods: First, we performed clinical validation on an internal data set.

Functional connectivity in resting-state networks relates to short-term global cognitive functioning in cardiac arrest survivors.

Long-term cognitive impairment is common in cardiac arrest survivors. Screening to identify patients at risk is recommended. Functional magnetic resonance brain imaging (fMRI) holds potential to contribute to prediction of cognitive outcomes.

Additional predictive value of optic nerve sheath diameter for neurological prognosis after cardiac arrest: a prospective cohort study.

Background: The goal is to estimate the additional value of ultrasonographic optic nerve sheath diameter (ONSD) measurement on days 1-3, on top of electroencephalography (EEG), pupillary light reflexes (PLR), and somatosensory evoked potentials (SSEP), for neurological outcome prediction of comatose cardiac arrest patients. We performed a prospective longitudinal cohort study in adult comatose patients after cardiac arrest. ONSD was measured on days 1-3 using ultrasound.

Free water corrected diffusion tensor imaging discriminates between good and poor outcomes of comatose patients after cardiac arrest.

Objectives: Approximately 50% of comatose patients after cardiac arrest never regain consciousness. Cerebral ischaemia may lead to cytotoxic and/or vasogenic oedema, which can be detected by diffusion tensor imaging (DTI). Here, we evaluate the potential value of free water corrected mean diffusivity (MD) and fractional anisotropy (FA) based on DTI, for the prediction of neurological recovery of comatose patients after cardiac arrest.

MRI markers of brain network integrity relate to neurological outcome in postanoxic coma.

Aim: Current multimodal approaches leave approximately half of the comatose patients after cardiac arrest with an indeterminate prognosis. Here we investigated whether early MRI markers of brain network integrity can distinguish between comatose patients with a good versus poor neurological outcome six months later.

Methods: We performed a prospective cohort study in 48 patients after cardiac arrest submitted in a comatose state to the Intensive Care Unit of two Dutch hospitals.

Prognosis After Cardiac Arrest: The Additional Value of DWI and FLAIR to EEG.

Background: Despite application of the multimodal European Resuscitation Council and European Society of Intensive Care Medicine algorithm, neurological prognosis of patients who remain comatose after cardiac arrest remains uncertain in a large group of patients. In this study, we investigate the additional predictive value of visual and quantitative brain magnetic resonance imaging (MRI) to electroencephalography (EEG) for outcome estimation of comatose patients after cardiac arrest.

Methods: We performed a prospective multicenter cohort study in patients after cardiac arrest submitted in a comatose state to the intensive care unit of two Dutch hospitals.

Outcome Prediction of Postanoxic Coma: A Comparison of Automated Electroencephalography Analysis Methods.

Background: To compare three computer-assisted quantitative electroencephalography (EEG) prediction models for the outcome prediction of comatose patients after cardiac arrest regarding predictive performance and robustness to artifacts.

Methods: A total of 871 continuous EEGs recorded up to 3 days after cardiac arrest in intensive care units of five teaching hospitals in the Netherlands were retrospectively analyzed. Outcome at 6 months was dichotomized as "good" (Cerebral Performance Category 1-2) or "poor" (Cerebral Performance Category 3-5).

Treating Rhythmic and Periodic EEG Patterns in Comatose Survivors of Cardiac Arrest.

Background: Whether the treatment of rhythmic and periodic electroencephalographic (EEG) patterns in comatose survivors of cardiac arrest improves outcomes is uncertain.

Methods: We conducted an open-label trial of suppressing rhythmic and periodic EEG patterns detected on continuous EEG monitoring in comatose survivors of cardiac arrest. Patients were randomly assigned in a 1:1 ratio to a stepwise strategy of antiseizure medications to suppress this activity for at least 48 consecutive hours plus standard care (antiseizure-treatment group) or to standard care alone (control group); standard care included targeted temperature management in both groups.

The Montreal Cognitive Assessment is a valid cognitive screening tool for cardiac arrest survivors.

Aim: The survival rate of out-of-hospital cardiac arrest (OHCA) patients has increased over the past decades. This gives rise to a growing number of patients with hypoxic-ischemic brain damage and cognitive impairment. Currently, cognitive impairment is underdiagnosed in OHCA patients.

EEG functional connectivity contributes to outcome prediction of postanoxic coma.

Objective: To investigate the additional value of EEG functional connectivity features, in addition to non-coupling EEG features, for outcome prediction of comatose patients after cardiac arrest.

Methods: Prospective, multicenter cohort study. Coherence, phase locking value, and mutual information were calculated in 19-channel EEGs at 12 h, 24 h and 48 h after cardiac arrest.

Dynamic functional connectivity of the EEG in relation to outcome of postanoxic coma.

Objective: Early EEG contains reliable information for outcome prediction of comatose patients after cardiac arrest. We introduce dynamic functional connectivity measures and estimate additional predictive values.

Methods: We performed a prospective multicenter cohort study on continuous EEG for outcome prediction of comatose patients after cardiac arrest.

EEG reactivity testing for prediction of good outcome in patients after cardiac arrest.

Objective: To determine the additional value of EEG reactivity (EEG-R) testing to EEG background pattern for prediction of good outcome in adult patients after cardiac arrest (CA).

Methods: In this post hoc analysis of a prospective cohort study, EEG-R was tested twice a day, using a strict protocol. Good outcome was defined as a Cerebral Performance Category score of 1-2 within 6 months.

Relevance of Somatosensory Evoked Potential Amplitude After Cardiac Arrest.

We present relations of SSEP amplitude with neurological outcome and of SSEP amplitude with EEG amplitude in comatose patients after cardiac arrest. This is a analysis of a prospective cohort study in comatose patients after cardiac arrest. Amplitude of SSEP recordings obtained within 48-72 h, and EEG patterns obtained at 12 and 24h after cardiac arrest were related to good (CPC 1-2) or poor (CPC 3-5) outcome at 6 months.

Delirium after cardiac arrest: Phenotype, prediction, and outcome.

Aim: To establish incidence, phenotype, long-term functional outcome, and early EEG predictors of delirium after cardiac arrest.

Methods: This is an ad hoc analysis of a prospective cohort study on outcome prediction of comatose patients after cardiac arrest. Patients with recovery of consciousness, who survived until hospital discharge, were subdivided in groups with and without delirium based on psychiatric consultation.

Association between somatosensory evoked potentials and EEG in comatose patients after cardiac arrest.

Objective: To analyze the association between SSEP results and EEG results in comatose patients after cardiac arrest, including the added value of repeated SSEP measurements.

Methods: Continuous EEG was measured in 619 patients during the first 3-5 days after cardiac arrest. SSEPs were recorded daily in the first 55 patients, and on indication in later patients.

Increased gamma and decreased fast ripple connections of epileptic tissue: A high-frequency directed network approach.

Objective: New insights into high-frequency electroencephalographic activity and network analysis provide potential tools to improve delineation of epileptic tissue and increase the chance of postoperative seizure freedom. Based on our observation of high-frequency oscillations "spreading outward" from the epileptic source, we hypothesize that measures of directed connectivity in the high-frequency range distinguish epileptic from healthy brain tissue.

Methods: We retrospectively selected refractory epilepsy patients with a malformation of cortical development or tumor World Health Organization grade I/II who underwent epilepsy surgery with intraoperative electrocorticography for tailoring the resection based on spikes.

Electroencephalographic reactivity as predictor of neurological outcome in postanoxic coma: A multicenter prospective cohort study.

Objective: Outcome prediction in patients after cardiac arrest (CA) is challenging. Electroencephalographic reactivity (EEG-R) might be a reliable predictor. We aimed to determine the prognostic value of EEG-R using a standardized assessment.

Brain imaging in comatose survivors of cardiac arrest: Pathophysiological correlates and prognostic properties.

Introduction: Hypoxic-ischemic brain injury is the main cause of death and disability of comatose patients after cardiac arrest. Early and reliable prognostication is challenging. Common prognostic tools include clinical neurological examination and electrophysiological measures.

Precision medicine in circadian rhythm sleep-wake disorders: current state and future perspectives.

In circadian rhythm sleep-wake disorders precision medicine is less developed than in other medical disciplines mainly because homeostatic sleep and circadian timing have a very complex phenotype with multiple genetic regulation mechanisms. However, biomarkers, phenotyping and psychosocial characteristics are increasingly used. Devices for polysomnography, actigraphy and sleep-tracking applications in mobile phones and other consumer devices with eHealth technologies are increasingly used.

Prospective risk analysis adjusted to the reality of clinical and fertility laboratory processes.

Background: Prospective risk analysis (PRA) is a valuable instrument in quality assurance. The practical application of PRA in clinical laboratories according to the method we have described elsewhere leaves room for a number of adaptations to make it more applicable to and consistent with actual laboratory processes.

Methods: We distinguished between more and less critical tests and products in the laboratory processes and scored the consequences of failures at different steps in line with the previously described failure type and effect analysis (FMEA) method.

Why the dim light melatonin onset (DLMO) should be measured before treatment of patients with circadian rhythm sleep disorders.

Treatment of circadian rhythm sleep disorders (CRSD) may include light therapy, chronotherapy and melatonin. Exogenous melatonin is increasingly being used in patients with insomnia or CRSD. Although pharmacopoeias and the European food safety authority (EFSA) recommend administering melatonin 1-2 h before desired bedtime, several studies have shown that melatonin is not always effective if administered according to that recommendation.

CYP1A2 polymorphisms in slow melatonin metabolisers: a possible relationship with autism spectrum disorder?

Background: In some of our patients with intellectual disabilities (ID) and sleep problems, the initial good response to melatonin disappeared within a few weeks after starting treatment. In these patients melatonin levels at noon were extremely high (>50 pg/ml). We hypothesise that the disappearing effectiveness is associated with slow metabolisation of melatonin because of a single nucleotide polymorphism (SNP) of CYP1A2.

Evaluation of salivary melatonin measurements for Dim Light Melatonin Onset calculations in patients with possible sleep-wake rhythm disorders.

Background: Dim Light Melatonin Onset (DLMO) can be calculated within a 5-point partial melatonin curve in saliva collected at home. We retrospectively analyzed the patient melatonin measurements sample size of the year 2008 to evaluate these DLMO calculations and studied the correlation between diary or polysomnography (PSG) sleep onset and DLMO.

Methods: Patients completed an online questionnaire.

Loss of response to melatonin treatment is associated with slow melatonin metabolism.

Background: In some of our patients with intellectual disability (ID) and sleep problems, the initial good response to melatonin disappeared within a few weeks after starting treatment, while the good response returned only after considerable dose reduction. The cause for this loss of response to melatonin is yet unknown. We hypothesise that this loss of response is associated with slow melatonin metabolism.