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The updated ESAIC guideline on postoperative delirium (POD) comprises a total of 13 recommendations, including five with the recommendation grade "strong": 1.) The assessment of preoperative POD risk factors, 2.) the optimisation of the preoperative condition, 3.) the discussion of prevention strategies, 4) the implementation of a non-pharmacological multicomponent intervention in patients at risk of POD and 5.) the risk-benefit assessment of the prophylactic administration of dexmedetomidine. The latter applies in particular due to the partly contradictory data situation and different areas of application (cardiac surgery versus non-cardiac surgery patients). Index-based EEG monitoring of the depth of anaesthesia is also recommended, whereby other parameters such as burst suppression and density spectral array should also be included. If non-pharmacological measures fail, POD should be treated with haloperidol. In contrast, the use of benzodiazepines is not recommended. [ABSTRACT FROM AUTHOR]

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Electroencephalogram (EEG)-guided anesthesia is indispensable in modern operating rooms and has become established as the standard form of monitoring. Many anesthesiologists rely on processed EEG indices in the hope of averting anesthesia-related complications, such as intraoperative awareness, postoperative delirium and other cognitive complications in their patients. This educational review aims to provide information on the five most prevalent monitors used to guide depth of sedation during general anesthesia. This article elucidates the principles underpinning the application of these monitors where known, which are generally based on power in various EEG frequency bands and on the burst suppression pattern. Convinced that EEG-guided anesthesia has the potential of benefitting many surgical patients, it is felt that many basic principles and shortcomings of processed EEG indices need to be better understood in the clinical practice. After discussing the different monitors and clinically relevant data from the literature, the article gives a short practical guidance on how to critically interpret processed EEG information and troubleshooting of confounded indices in the context of clinical situations. [ABSTRACT FROM AUTHOR]

Abstract: There are presently no studies investigating the effects of transcranial alternating current stimulation (tACS) on complex precision sports such as golf. For the golf putt, previous electrophysiological studies indicate a connection between putt performance and EEG alpha activity. Here, we investigate whether alpha-tACS over the motor cortex improves golf putting. To this end, 15 advanced golfers each received either alpha-tACS or sham stimulation in three blocks of 50 putts before, during, and after stimulation. We measured both movement execution (repeatability) and movement result (distance control) as dependent variables. We did not find an enhancing effect of alpha-tACS on golf putting performance. [ABSTRACT FROM AUTHOR]

In Germany, long-term video EEG as the gold standard for the diagnostics of epilepsy and other seizure disorders, is currently only available for inpatient monitoring in a limited number of specialized centers. These limited monitoring capacities and the large amount of associated time and work resources lead to a significant waiting time for this important diagnostic procedure nationwide. New portable sensor technology and automated data analysis methods are creating opportunities for gold standard long-term video EEG assessments in outpatient settings, which may help to resolve this barrier. Here, we report the results of a single-center feasibility study by implementing outpatient long-term video EEG (ALVEEG) as a diagnostic pathway in Germany. In the new diagnostic pathway, the use of innovative, portable video EEG monitoring systems along with artificial intelligence-assisted data analysis are intended to provide those patients affected by seizure disorders with a more rapid, efficient, and cross-sectoral access to gold standard diagnostics in the home environment. The diagnostics were well accepted by patients and clinicians and may represent a complementary option to inpatient monitoring to eliminate current bottlenecks in diagnostics and care. [ABSTRACT FROM AUTHOR]

Status epilepticus is characterized by persistent or repetitive seizures which, without successful treatment, can lead to neuronal damage, neurological deficits and death of the patient. While status epilepticus with motor symptoms can usually be clinically diagnosed, nonconvulsive status epilepticus is often clinically overlooked due to its ambiguous semiology, so that electroencephalography (EEG) recording is necessary. The treatment of status epilepticus is performed in four treatment steps, whereby a difficult to treat status epilepticus is present from the third step at the latest and intensive medical care of the patient is necessary. Timely initiation of treatment and sufficient dosage of anticonvulsive medication are decisive for the success of treatment. There is little evidence for the "late" stages of treatment. Intensive medical measures pose the risk of complications that worsen the prognosis. Especially in nonconvulsive status epilepticus, the use of anesthetics must be weighed against possible complications of mechanical ventilation. [ABSTRACT FROM AUTHOR]

Background: The sleep spindle is a graphoelement of an electroencephalogram (EEG), which can be observed in light and deep sleep. Alterations in spindle activity have been described for a range of psychiatric disorders. Due to their relatively constant properties, sleep spindles may therefore be potential biomarkers in psychiatric diagnostics. Method: This article presents an overview of the state of the science on the characteristics and functions of the sleep spindle as well as known alterations of spindle activity in psychiatric disorders. Various methodological approaches and developments of spindle detection are explained with respect to their potential for application in psychiatric diagnostics. Results and conclusion: Although alterations in spindle activity in psychiatric disorders are known and have been described in detail, their exact potential for psychiatric diagnostics has yet to be fully determined. In this respect, the acquisition of knowledge in research is currently constrained by manual and automated methods for spindle detection, which require high levels of resources and are error prone. Newer approaches to spindle detection based on deep-learning procedures could overcome the difficulties of previous detection methods, and thus open up new possibilities for the practical application of sleep spindles as biomarkers in the psychiatric practice. [ABSTRACT FROM AUTHOR]

Background: The diagnostics of autism spectrum disorder is complex due to missing biological markers and numerous comorbidities. The aim was to assess the role of neuropediatric diagnostics and to develop a standard operating procedure for a targeted assessment., Method: All patients presenting to the neuropediatric outpatient clinic at Saarland University Hospital between April 2014 and December 2017 with ICD code F84 pervasive developmental disorders were included., Results: A total of 82 patients were included (male 78%, female 22%; mean age 5.9 ± 2.9 years, range 2-16 years). The most frequent examination was electroencephalography (EEG) (74/82; 90.2%) with pathological findings in 33.8% (25/74). Based on the history and/or EEG epilepsy was diagnosed in 19.5% (16/82). Magnetic resonance imaging (MRI) was performed in 49/82 (59.8%) patients, 22/49 (44.9%) showed at least 1 cerebral abnormality and definite pathologies could be detected in 63.6% (14/22). A metabolic diagnostic work-up was performed in 44/82 (53.7%) cases and in 5/44 (11.4%) it resulted in a diagnosis or suspicion of a metabolic disease. Genetic testing results were available in 29/82 (35.4%) children and 12/29 (41.4%) showed abnormal results. Delay in motor development was more frequently associated with comorbidities, EEG abnormalities, epilepsy and abnormalities in metabolic and genetic testing., Conclusion: Neuropediatric examination in cases of suspected autism should include a detailed history, a thorough neurological examination and an EEG. An MRI, comprehensive metabolic and genetic testing are only recommended if clinically indicated., (© 2023. The Author(s).)

Background: To improve the sensitivity of the EEG in the diagnosis and classification of seizures or epilepsy, long-term recording with inferior temporal electrodes are recommended. Material and methods: The spatial distribution of epileptiform discharges from 24‑h EEG with 25 electrodes (10–20, extended by F9/F10, T9/T10, P9/P10) was retrospectively analyzed in 25 cases. Results: Maximum negativity was located below the 10–20 electrodes in 84%. Epileptiform discharges were more clearly detected on inferior temporal electrodes in 64%. In the intention-to-test population of 77 patients the number needed to test with extra electrodes was estimated as 5. Conclusion: Recording EEG with 25 electrodes for 24 h improves the detection and localization of temporal epileptiform discharges also in geriatric patients with suspected nonlesional epilepsy. [ABSTRACT FROM AUTHOR]

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Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Language processing can be measured objectively using late components in the evoked brain potential. The most established component in this area of research is the N400 component, a negativity that peaks at about 400 ms after stimulus onset with a centro-parietal maximum. It reflects semantic processing. Its presence, as well as its temporal and quantitative expression, allows to conclude about the quality of processing. It is therefore suitable for measuring speech comprehension in special populations, such as cochlear implant (CI) users. The following is an overview of the use of the N400 component as a tool for studying language processes in CI users. We present studies with adult CI users, where the N400 reflects the quality of speech comprehension with the new hearing device and we present studies with children where the emergence of the N400 component reflects the acquisition of their very first vocabulary., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Copyright of Anaesthesiologie & Intensivmedizin is the property of DGAI e.V. - Deutsche Gesellschaft fur Anasthesiologie und Intensivmedizin e.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Zeitschrift für Epileptologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Zeitschrift für Epileptologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Zeitschrift für Epileptologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article reports that the EEG amendment at the end of 2021 led to the EEG 2021 and thus to only one major change for hydropower as the additional so-called "3 cent bonus" for hydroelectric power plants up to and including 500 kW output. Topics include considered that this additional bonus is to be welcomed and, in view of the electricity production costs especially in the difficult situation caused by dry years appropriate.

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Reference values/intervals are generally used in medicine as a basis for diagnostic evaluation of patient-related findings. The American Academy of Sleep Medicine recommends a basic set of parameters that must be presented in the report of a polysomnographic examination. These include respiratory events, movement events, cardiac events, arousal events, and sleep scoring data. The present paper refers to reference values for sleep scoring data that characterize sleep architecture. Methodological aspects of the construction of reference intervals (statistical and choice of a reference sample), presentation options (tables and figures), and the scope of application (use of different reference values for data recorded and evaluated according to the Rechtschaffen and Kales and AASM standard) are discussed. [ABSTRACT FROM AUTHOR]

The determination of the irreversible cessation of brain function (ICBF) is conducted in Germany according to the guideline of the German Medical Association, which is currently its fourth update issued in July 2015. This article provides an assessment of the current situation including an international comparison. International case reports with allegedly incorrect ICBF diagnosis are reviewed from the point of view of the German guideline. These case reports underpin the validity of the German guideline, especially its following provisions: (1) in patients with known or suspected adaptation to chronic hypercapnia, apnea cannot be diagnosed as usual; therefore in such a case the proof of cerebral circulatory arrest is mandatory; (2) if perfusion scintigraphy is used for proof of cerebral circulatory arrest, only validated lipophilic radiopharmaceuticals are allowed. This is compatible with new research data which indicate that cellular function can be reactivated for several hours after circulatory arrest but not the brain function. The recently updated recommendations of the German Society for Clinical Neurophysiology and Functional Imaging (DGKN) for ancillary testing include editorial adaptations (e.g., the more precise specification of the electrode positions for electroencephalography), standards of display screen with digital electroencephalography and age-related minimum values of mean arterial pressure for Doppler and duplex sonography in children. The novel requirements regarding the institutional organization of ICBF diagnostics in Germany issued in the "Second law on the amendment of transplantation law—improvement of the cooperation and the framework for organ donation" that became effective recently are presented and discussed critically in this review. [ABSTRACT FROM AUTHOR]

Background: The pathophysiology behind tinnitus is still not well understood. Different imaging methods help in the understanding of the complex relationships that lead to the perception of tinnitus., Objective: Herein, different functional imaging methods that can be used in the study of tinnitus are presented., Materials and Methods: Considering the recent literature on the subject, the relevant imaging methods used in tinnitus research are discussed., Results and Conclusion: Functional imaging can reveal correlates of tinnitus. Due to the still limited temporal and spatial resolution of current imaging modalities, a conclusive explanation of tinnitus remains elusive. With increasing use of functional imaging, additional important insights into the explanation of tinnitus will be gained in the future., (© 2023. The Author(s).)

Polysomnography (PSG) is the standard procedure to examine human sleep and its disorders. The basis of PSG was the discovery of the electroencephalogram (EEG). Performance and evaluation should follow standardized, evidence-based criteria, which are subject to permanent validation (American Academy of Sleep Medicine [AASM] manual). These rules provide technical specifications, recommendations for the positioning of electrodes, and definitions for how sleep should be scored. They also stipulate the criteria that have to be fulfilled in order to diagnose sleep-related events such as arousals, apneas, and leg movements. [ABSTRACT FROM AUTHOR]

Besides very low depth of anesthesia (DOA) index values, special intraoperative electroencephalography (EEG) patterns, such as burst suppression patterns and the correlation with postoperative delirium and mortality have been examined. Over the last decade the 13 studies described in this article yielded information that documented low DOA indices or burst suppression patterns increased the risk of either postoperative cognitive dysfunction or mortality; however, these were mainly secondary data analyses or retrospective observational studies. The first prospective interventional study regarding triple low could not confirm this correlation. Meanwhile, the first prospective interventional studies on avoidance of excessive EEG suppression are currently in progress. The results would not only enable the formulation of evidence-based recommendations but should also provide indicatíons and references as to whether the above mentioned observations can be explained by a causal association or an epiphenomenon. [ABSTRACT FROM AUTHOR]

Therapeutic non-invasive transcranial brain stimulation with previous treatment protocols showed at best moderate effect sizes and large interindividual variability with a substantial proportion of non-responders. A currently intensively discussed approach to address these problems is individualized closed-loop stimulation. ConnectToBrain is a synergy project funded by the European Research Council to develop noninvasive closed-loop therapeutic stimulation of network disorders of the human brain. It consists of three main pillars: (1) development of a multichannel transcranial magnetic stimulation (mTMS) coil array that covers nearly all of the cerebral cortex and enables highly precise electronic control of location, direction, intensity and timing of the induced electrical fields, (2) development of real-time analysis of activity and connectivity in brain networks using electroencephalography (EEG) for instantaneous spatial and temporal control of stimulation (brain state-dependent, closed-loop stimulation) and adaptive optimization of treatment effects by machine learning and (3) translation of these neurotechnological innovations into physiological and clinical studies. [ABSTRACT FROM AUTHOR]

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Zusammenfassung Trotz zunehmender Automatisierung elektrophysiologischer Diagnostikverfahren in der Medizin stützt sich die Analyse elektroenzephalographischer Kurven in der Routinediagnostik weiterhin überwiegend auf visuelle Mustererkennung und deren Interpretation. Besondere Schwierigkeiten können hierbei im Rahmen der Differenzierung steil akzentuierter Potentialmuster entstehen und deren Einteilung in Artefakte, Normvarianten oder pathologische Aktivität, die die Grundlage einer jeden Befundung darstellt. Dieser Übersichtartikel hat das Ziel häufige steil konfigurierte Graphoelemente darzustellen und deren jeweilige Charakteristika zu beschreiben, wobei sowohl auf physiologische Transienten, als auch auf Graphoelemente unklarer Signifikanz sowie epilepsietypische Potentiale eingegangen wird. Summary The knowledge and correct interpretation of electroencephalographic (EEG)-pattern constitute the clinical hallmark of reliable EEG analysis. In particular, discrimination between epileptiform discharges and normal variants of sharp potentials can be challenging but remains crucial for EEG interpretation and planning of further diagnostic or therapeutic steps. The aim of this article is to demonstrate, characterize and discuss the hallmarks of frequent and rare physiological and epileptiform sharp configurated EEG-potentials. [ABSTRACT FROM AUTHOR]

Electroencephalogram (EEG)-guided anesthesia is indispensable in modern operating rooms and has become established as the standard form of monitoring. Many anesthesiologists rely on processed EEG indices in the hope of averting anesthesia-related complications, such as intraoperative awareness, postoperative delirium and other cognitive complications in their patients. This educational review aims to provide information on the five most prevalent monitors used to guide depth of sedation during general anesthesia. This article elucidates the principles underpinning the application of these monitors where known, which are generally based on power in various EEG frequency bands and on the burst suppression pattern. Convinced that EEG-guided anesthesia has the potential of benefitting many surgical patients, it is felt that many basic principles and shortcomings of processed EEG indices need to be better understood in the clinical practice. After discussing the different monitors and clinically relevant data from the literature, the article gives a short practical guidance on how to critically interpret processed EEG information and troubleshooting of confounded indices in the context of clinical situations., (© 2023. The Author(s).)

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Zusammenfassung In Studien mit bildgebenden Verfahren (z.B. fMRT) fanden sich im Zusammenhang mit Stimuli (positives oder negatives Feedback), die durch das zentrale Belohnungssystem verarbeitet werden, Veränderungen der neuronalen Aktivität in verschiedenen kortikalen und subkortikalen Hirnregionen. Im Rahmen einer EEG-Studie wurde ein Paradigma entwickelt, um ereigniskorrelierte Potentiale (ERP) und EEG-Oszillationen (ERO) in Zusammenhang mit Gewinn- oder Verlust-Feedback elektrophysiologisch abzuleiten und zu analysieren. Sowohl die ERP als auch die Oszillationen weisen nach einem Gewinn- oder Verlust-Feedback gegenüber einer neutralen Bedingung Unterschiede auf, sodass die Aktivität des zentralen Belohnungssystems auch elektrophysiologisch differenziell untersucht werden kann. Summary Previous neuroimaging studies identified brain areas associated with reward processing following reward or punishment and showed altered neuronal activities. The present study aimed to examine whether feedback-based experiences of gains and losses are associated with electrophysiological correlates. Healthy participants were investigated using a gambling task, which focused on non-predictable gain and loss experiences. Electroencephalography (EEG) recordings were performed during task execution to assess electrophysiological correlates of reward processing. Event-related potentials (ERPs) and event-related oscillations (EROs) were analysed upon feedback of gains/losses. Pilot data revealed that such a gambling paradigm is useful to measure differences of feedback-related changes for gains/losses. Thus, electrophysiological techniques can be used to investigate feedback processing on a gambling task indicating brain reward processing. [ABSTRACT FROM AUTHOR]

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Hintergrund: Die Richtlinien der Bundesärztekammer und der Deutschen Gesellschaft für Klinische Neurophysiologie und Funktionelle Bildgebung (DGKN) stellen hohe formale und technische Anforderungen an die Elektroenzephalographie (EEG) als Zusatzverfahren bei der Feststellung des irreversiblen Hirnfunktionsausfalls (IHA, „Hirntod“). In den Kliniken kommen zunehmend digitale EEG-Systeme zum Einsatz. Offen ist bislang, inwieweit diese die richtliniengemäßen Vorgaben an die IHA-Diagnostik erfüllen.Methoden: Die technischen und Sicherheitsanforderungen an digitale EEG-Systeme und die EEG-Dokumentation bei der IHA-Diagnostik werden ausführlich dargestellt. Die Autoren führten im Namen der DGKN eine schriftliche Abfrage bei allen recherchierten Anbietern digitaler EEG-Systeme in Deutschland zu den folgenden Anforderungen durch: wiederholte Speicherung von Kalibriersignalen („Eichsignalen“) während laufender EEG-Aufzeichnung, wiederholte Speicherung der Impedanzwerte aller Elektroden während laufender EEG-Aufzeichnung, Prüfung des Geräterauschens, galvanische Trennung von Messerdung und Schutzleiter („floating input“).Ergebnisse: Für 15 der recherchierten 20 verschiedenen digitalen EEG-Systeme wurden die zugesandten Fragen von den Anbietern (u. a. aller mit Sitz in Deutschland) beantwortet. Alle diese EEG-Systeme weisen das sicherheitstechnische Merkmal der galvanischen Trennung zwischen Messerdung und Schutzleiter auf. Die Testung des Geräterauschens ist mit allen Systemen möglich. Allerdings erlauben nicht alle Systeme die Speicherung von Kalibriersignalen und/oder von Impedanzen während einer laufenden EEG-Aufzeichnung.Schlussfolgerung: Viele, aber nicht alle der heute für die Klinik angebotenen digitalen EEG-Systeme sind für den Einsatz bei der IHA-Diagnostik geeignet. [ABSTRACT FROM AUTHOR]