title: Consensus on the use of neurophysiological tests in the intensive care unit (ICU): electroencephalogram (EEG), evoked potentials (EP), and electroneuromyography (ENMG).
abstract: OBJECTIVE
  To provide a consensus of European leading authorities about the optimal use of clinical neurophysiological (CN) tests (electroencephalogram [EEG]; evoked potentials [EP]; electroneuromyography [ENMG]) in the intensive care unit (ICU) and, particularly, about the way to make these tests clinically useful for the management of individual patients.
  
  
  METHODS
  This study gathered together several European clinical neurophysiologists and neurointensivists whose leading contributions in the adult or paediatric ICU and in continuous neuromonitoring had been peer-acknowledged. It was based on both a literature review and each participant's own experience. Given the methodological impossibility to gather studies fulfilling criteria of evidence-based medicine, this article essentially relies on expert opinions that were gained after several rounds, in which each expert was invited to communicate his own contribution to all other experts. A complete consensus has been reached when submitting the manuscript.
  
  
  RESULTS
  What the group considered as the best classification systems for EEG and EP abnormalities in the ICU is first presented. CN tests are useful for diagnosis (epilepsy, brain death, and neuromuscular disorders), prognosis (anoxic ischemic encephalopathy, head trauma, and neurologic disturbances of metabolic and toxic origin), and follow-up, in the adult, paediatric, and neonatal ICU. Regarding prognosis, a clear distinction is made between these tests whose abnormalities are indicative of an ominous prognosis and those whose relative normalcy is indicative of a good prognosis. The prognostic significance of any test may vary as a function of coma etiology.
  
  
  CONCLUSIONS
  CN provides quantitative functional assessment of the nervous system. It can be used in sedated or curarized patients. Therefore, it should play a major role in the individual assessment of ICU patients.
authors.affiliation: Neurologie, Chirec, clinique Edith-Cavell, 32, rue Edith-Cavell, 1180 Brussels, Belgium. jean-michel.guerit@chirec.be
authors.forename: J-M
authors.initials: JM
authors.lastname: Guérit
authors.forename: A
authors.initials: A
authors.lastname: Amantini
authors.forename: P
authors.initials: P
authors.lastname: Amodio
authors.forename: K V
authors.initials: KV
authors.lastname: Andersen
authors.forename: S
authors.initials: S
authors.lastname: Butler
authors.forename: A
authors.initials: A
authors.lastname: de Weerd
authors.forename: E
authors.initials: E
authors.lastname: Facco
authors.forename: C
authors.initials: C
authors.lastname: Fischer
authors.forename: P
authors.initials: P
authors.lastname: Hantson
authors.forename: V
authors.initials: V
authors.lastname: Jäntti
authors.forename: M-D
authors.initials: MD
authors.lastname: Lamblin
authors.forename: G
authors.initials: G
authors.lastname: Litscher
authors.forename: Y
authors.initials: Y
authors.lastname: Péréon
mesh_terms: D000328:Adult; D001926:Brain Death / Q000175:diagnosis; D001930:Brain Injuries / Q000175:diagnosis / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D003128:Coma / Q000209:etiology / Q000503:physiopathology; D003422:Critical Care / Q000379:methods* / Q000592:standards; D004568:Electrodiagnosis / Q000379:methods / Q000592:standards; D004569:Electroencephalography / Q000187:drug effects / Q000379:methods; D004576:Electromyography / Q000379:methods; D004827:Epilepsy / Q000175:diagnosis; D005071:Evoked Potentials; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology; D002534:Hypoxia, Brain / Q000175:diagnosis / Q000503:physiopathology; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000503:physiopathology; D007362:Intensive Care Units; D007363:Intensive Care Units, Neonatal; D008991:Monitoring, Physiologic / Q000379:methods* / Q000592:standards; D009468:Neuromuscular Diseases / Q000175:diagnosis; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012720:Severity of Illness Index
chemical_list: D006993:Hypnotics and Sedatives