Noninvasive continuous monitoring of cerebral oxygenation periictally using near-infrared spectroscopy: a preliminary report.
OBJECTIVE
To report on the use of near-infrared spectroscopy (NIRS) to examine the changes in cerebral oxygenation in the periictal period in patients with seizures.


METHODS
Cerebral hemoglobin oxygen availability was monitored continuously and noninvasively with NIRS in three patients (one in the pediatric intensive care unit (ICU) and two in epilepsy-monitoring units) in conjunction with continuous EEG monitoring. Ictal events were recorded and compared with the pre-, intra-, and postictal periods for cerebral oxygen availability, as defined by oxygenated hemoglobin (HbO2), deoxygenated hemoglobin (Hb), and the redox state of cytochrome oxidase (cytox).


RESULTS
Several important preliminary observations were made by using this technology. First, a preictal increase in cerebral oxygenation began between 1 and 2 h and >10 h before the ictal event. Second, despite adequate perfusion, based on an observed increased HbO2, reduction in cytox indicates a perfusion-metabolism mismatch during seizure activity. Third, continued seizure activity and even isolated ictal events were associated with decreased cerebral oxygen availability. Fourth, differences in cerebral oxygen availability were noted between different types of seizures (e.g., electrographic seizures were accompanied by rapid reductions in HbO2 and cerebral blood volume without reduction of cytox, whereas electroclinical seizures were characterized by marked increases in HbO2 with or without reduction of cytox).


CONCLUSIONS
In this preliminary report on the use of NIRS for patients with seizures, we believe that NIRS allows continuous and noninvasive monitoring of changes in cerebral oxygenation periictally, thereby permitting investigations into the pathophysiology of seizures and the exploration of the potential of cerebral oximetry as a tool for seizure localization.
Adelson
P D
PD
Department of Neurosurgery, University of Pittsburgh and Children's Hospital of Pittsburgh, Pennsylvania, USA. adelsod@chplink.chp.edu
Nemoto
E
E
Scheuer
M
M
Painter
M
M
Morgan
J
J
Yonas
H
H
D001921:Brain / Q000378:metabolism* / Q000503:physiopathology; D004569:Electroencephalography / Q000706:statistics & numerical data; D003576:Electron Transport Complex IV / Q000032:analysis; D004827:Epilepsy / Q000175:diagnosis / Q000378:metabolism* / Q000503:physiopathology; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D010100:Oxygen / Q000032:analysis* / Q000378:metabolism; D010108:Oxyhemoglobins / Q000032:analysis; D019265:Spectroscopy, Near-Infrared / Q000379:methods*
D006454:Hemoglobins; D010108:Oxyhemoglobins; D003576:Electron Transport Complex IV; D010100:Oxygen