Abstracts of Poster Presentations / Clinical Neurophysiology 125, Supplement 1 (2014) S1–S339 S177

mentation of sleep. Melatonin secretion was lower for patients with worsesleep, although biorhythm was visible in all but one patient. PSG withR&K analysis proved to be time-consuming and cumbersome, while the useof tandem mass spectrometry resulted in high throughput with excellentaccuracy.Conclusions: Taking the limited scope of this pilot into account, worseningcharacteristics of sleep seem to coincide with loss of circadian rhythm.Currently, the availability of materials and the time-consuming analysis ofPSG recordings are the main limiting factors of the study of sleep in theICU. Automated, objective measures of quality and quantity of sleep arecurrently being validated in ICU and non-ICU patients, using only singlechannel EEG data.

P478Prediction of good and poor outcome in comatose patients aftercardiac arrest: the utility of early EEG/SEP recordings duringtherapeutic hypothermia

M. Spalletti1, R. Carrai1,2, A. Comanducci1, C. Cossu1, S. Gabbanini1,A. Peris3, G. Gensini2,4, A. Grippo1,2, A. Amantini1,21AOU Careggi, Neurophysiopathology, Florence, Italy; 2IRCCS Don Gnocchi,Neurologic Rehabilitation Unit, Florence, Italy; 3AOU Careggi, ICU Emergency,Florence, Italy; 4AOU Careggi, Heart-Vessels, Florence, Italy

Question: Somatosensory evoked potentials (SEPs) are a reliable predictorof poor outcome in comatose patients after cardiac arrest (CA) treated withtherapeutic hypotermia (TH). The role of EEG has been recently emphasizedduring early phase after CA.Our aim is to evaluate the prognostic value of EEG and SEPs in post-anoxiccomatose patients within 12hs and 24hs from cardiac arrest (CA).Methods: Comatose patients after CA treated with TH were included. EEGand SEPs were recorded within 12hs and 24hs after CA. EEG was classifiedinto discontinous (low voltage, isoelectric, burst suppression) and con-tinuous (other patterns except epileptiform). SEPs were dicotomized into“bilaterally absent” (BA) and “present”. Neurologic outcome was evaluatedat 6 months by GOS: “awakening” (GOS 3-5) was considered good outcome.Results: EEG and SEPs were recorded in 72 patients: 25 of these werestudied within 12hs from CA.All patients with a continuous EEG pattern at 12hs awakened. The sameEEG pattern recorded at 24 hs was not always predictive of awakening. BASEPs at 12hs predicted poor outcome and were associated to discontinuousEEG patterns. Continuous EEG pattern was always associated with presentSEPs.Conclusion: Combined early EEG/SEPs recordings are a useful tool for reli-able prognostication both of good and poor outcome in comatose patientstreated with TH.

P479Continuous EEG monitoring in neurointensive care. Organisation andassessment of impact

M. Fabricius1, A. Sabers2, H. Hoegenhaven1, J. Brennum3, K. Moeller4,K. Hansen2, T.W. Kjaer11Rigshospitalet, Clinical neurophysiology, Copenhagen, Denmark;2Rigshospitalet, Neurology, Copenhagen, Denmark; 3Rigshospitalet,Neurosurgery, Copenhagen, Denmark; 4Rigshospitalet, Neuroanaesthesiology,Copenhagen, Denmark

Background: Continuous EEG (cEEG) is an emerging discipline for assess-ment of acute changes in cerebral function in the intensive care unit (ICU). Anumber of publications demonstrate that non-convulsive status epilepticusis a common complication in both neurological and non-neurological ICUpatients and that cEEG is superior to conventional 30 minute standard EEGin capturing these patients. Yet establishing cEEG as part of daily routineis resource demanding and raises a number of treatment-related issues.Furthermore cEEG as a daily routine must be carefully introduced to assurethat the most relevant patients are monitored, and that neurophysiologistsand clinicians communicate in an efficient way.Methods: At Rigshospitalet, cEEG for suspected non-convulsive statusepilepticus has been offered as a 24/7 service since april 2013. Record-ings are assessed by senior clinical neurophysiologists at no more thaneight hours interval, and a report is written directly into the patientselectronic records. Clinicians may phone the neurophysiologist around theclock for discussion or referral. After six month, a total of 67 patients had

been monitored with cEEG. At this time, an anonymous web-based surveywas performed addressing 168 clinicians within paediatrics, neurology,neurosurgery and neuroanaesthesiology.Results: We obtained 51 responses. Of these 74% were senior/consultantsand 26% trainees/researchers.48 (94%) found that cEEG was an important investigation in neurocriticalcare.50% of the clinicians had been involved in patients monitored with cEEG.Of those, 88% found that the logistics and communication with the neuro-physiologist worked optimally or quite well in the best case, and 76-80%on average.cEEG had an impact on clinical decision-making that was optimal in 76%(best) and 44% (average) of cases and quite good in 20% (best) and 52%(average) of cases. Only one clinician found cEEG suboptimal for clinicaldecision-making in the actual case.When additional indications for cEEG were asked for, monitoring of pa-tients with subarachnoid hemorrhage for delayed ischemia was the mostprevalent suggestion.Conclusion: In this survey cEEG is highly demanded and supports clinicaldecision-making in the vast majority of cases where non-convulsive statusepilepticus is suspected.

P480Treatment of electroencephalographic status epilepticus after cardiacarrest – retrospective analysis and notification of a multicenterrandomized controlled trial

J. Hofmeijer1,2, M. Tjepkema-Cloostermans1, M.J. Blans3, A. Beishuizen4,M.J.A. van Putten1,5

1University Twente, Clinical Neurophysiology, Enschede, Netherlands;2Rijnstate Hospital, Neurology, Arnhem, Netherlands; 3Rijnstate Hospital,Intensive Care, Arnhem, Netherlands; 4Medical Spectrum Twente, IntensiveCare, Enschede, Netherlands; 5Medical Spectrum Twente, ClinicalNeurophysiology, Enschede, Netherlands

Question: Electroencephalographic seizures, including status epilepticus,occur in 9-35% of comatose patients after cardiac arrest. Mortality is90-100% [1]. It is unclear whether (some) seizure patterns represent a con-dition in which treatment improves outcome, or severe ischemic damage,in which treatment is futile.Methods: In two teaching hospitals, we retrospectively identified patientsthat were treated with anti-epileptic drugs from our prospective cohortstudy on the prognostic value of continuous EEG monitoring in comatosepatients after cardiac arrest. Outcome at six months after cardiac arrestwas dichotomized between “good” (CPC 1 or 2) and “poor” (CPC 3, 4, or5). EEG analyses were done at 24 hours after cardiac arrest and duringanti-epileptic treatment, blinded for outcome.Results: Thirty-one (22%) of 139 patients were treated with anti-epilepticdrugs (fenytoin, levetiracetam, valproate, clonazepam, propofol, midazo-lam): two with one, nine with two, thirteen with three, five with four, onewith five, and one with six different drugs. This treatment improved epilep-tic EEG patterns temporarily (<6h). However, all but one patients withelectroencephalographic status epilepticus died. In patients with seizuresor GPDs at 24 hours, there was no difference in outcome between thosetreated with and without anti-epileptic drugs.Conclusion: In comatose patients after cardiac arrest with electroen-cephalographic status epilepticus, the general practice of treatment withconventional anti-epileptic drugs does not improve patients’ outcome. Amulticenter randomized controlled trial to estimate the effect of earlyand aggressive treatment, directed at complete suppression of epileptiformactivity during at least 24 hours, is in preparation.Reference:[1] Cloostermans 2012.

P482Reliable monitoring of respiration rate with reflectance-modephotoplethysmography

R. Paamand1, H.B.D. Sorensen2, D.B. Saadi2, H. Aydin1, P. Jennum1

1DCSM, Glostrup Hospital, Dept. of Clin. Neurophysiology, Glostrup, Denmark;2Technical University of Denmark, DTU Electro, Biomedical Signal Processing,Copenhagen, Denmark

Problem: Recent innovations in embedded, networked sensors have en-