Automated Pupillometry for Assessment of Treatment Success in Nonconvulsive Status Epilepticus

Godau, Jana; Bharad, Kaushal; Rösche, Johannes; Nagy, Gábor; Kästner, Stefanie; Weber, Klaus; Bösel, Julian

doi:10.1007/s12028-021-01273-6

Cited by 10 publications

(9 citation statements)

References 39 publications

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“…After ASM therapy, 77.6% of the minNPi values were normalized in the treatment responder group among the NCSE-terminated patients (n = 66). Moreover, the improvement in minNPi was significant according to the responsiveness of each ASM in responder groups [33]. Therefore, a quantitative pupillometer could be a useful non-invasive neuromonitoring tool for the diagnosis and treatment responsiveness of NCSE.…”

Section: Monitoring In Nonconvulsive Status Epilepticusmentioning

confidence: 91%

“…In particular, evaluating PLR ≥ 72 hours after the return of spontaneous circulation (ROSC) using a quantitative pupillometer is emerging as a helpful examination to evaluate brainstem function in post-CA patients [26,27]. Several studies have evaluated the relationship between pupillometer parameters and prognostication following CA (Table 2) [1,11,12,[28][29][30][31][32][33][34][35]. A prospective study of out-of-hospital cardiac arrest (OHCA) patients treated with targeted temperature management (TTM) at 33°C with sedation and neuromuscular blocking agents reported that the quantitative %CH on days 1 and 2 were associated with poor outcomes at 90 days (cerebral performance categories [CPCs] 3-5).…”

Section: Prognosis In Patients With Post-cardiac Arrestmentioning

confidence: 99%

“…The lowest NPis of both sides <4.0 and the absolute difference of NPi on both sides >0.2 are associated with NCSE. Godau et al [33] A prospective observational study of patients with NCSE (n=68)…”

Section: Ncse Godau Et Al [32]mentioning

confidence: 99%

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Quantitative assessments of pupillary light reflexes in neurocritically ill patients

Kim

2022

J Neurocrit Care

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The pupillary light reflex (PLR) is a component of bedside neurological examinations in neurological intensive care units (neuroICUs). A quantitative pupillometer provides a non-invasive and objective pupil reactivity parameter clinically significant for changes in PLR in neuroICUs. This article reviews the physiology and importance of the PLR and the parameters of quantitative pupillometers. Moreover, this review discusses the clinical applications of quantitative pupillometers for post-cardiac arrest prognostication and monitoring of elevated intracranial pressure and neurological worsening in stroke, seizures, and other neurological diseases in the neuroICU. Quantitative pupillometry is a routine part of neurological examinations and an important monitoring tool for neurological diseases in neuroICUs.

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Section: Monitoring In Nonconvulsive Status Epilepticusmentioning

confidence: 91%

Section: Prognosis In Patients With Post-cardiac Arrestmentioning

confidence: 99%

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Quantitative assessments of pupillary light reflexes in neurocritically ill patients

Kim

2022

J Neurocrit Care

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“…Pupillary metrics using AP may assist in neuroprognostication. Normal PLR measured using AP has been associated with improved neurologic outcomes after cardiac arrest, hemicraniectomy, and successful treatment for nonconvulsive status epilepticus (8,9,(14)(15)(16)(17)(18). There is a need for high-quality evidence, especially one correlating its use with clinical outcomes, before wider acceptance of this device.…”

Section: Automated Pupillometrymentioning

confidence: 99%

Neuromonitoring in Critically Ill Patients

Rajagopalan

Sarwal

2023

Critical Care Medicine

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OBJECTIVES: Critically ill patients are at high risk of acute brain injury. Bedside multimodality neuromonitoring techniques can provide a direct assessment of physiologic interactions between systemic derangements and intracranial processes and offer the potential for early detection of neurologic deterioration before clinically manifest signs occur. Neuromonitoring provides measurable parameters of new or evolving brain injury that can be used as a target for investigating various therapeutic interventions, monitoring treatment responses, and testing clinical paradigms that could reduce secondary brain injury and improve clinical outcomes. Further investigations may also reveal neuromonitoring markers that can assist in neuroprognostication. We provide an up-to-date summary of clinical applications, risks, benefits, and challenges of various invasive and noninvasive neuromonitoring modalities. DATA SOURCES: English articles were retrieved using pertinent search terms related to invasive and noninvasive neuromonitoring techniques in PubMed and CINAHL. STUDY SELECTION: Original research, review articles, commentaries, and guidelines. DATA EXTRACTION: Syntheses of data retrieved from relevant publications are summarized into a narrative review. DATA SYNTHESIS: A cascade of cerebral and systemic pathophysiological processes can compound neuronal damage in critically ill patients. Numerous neuromonitoring modalities and their clinical applications have been investigated in critically ill patients that monitor a range of neurologic physiologic processes, including clinical neurologic assessments, electrophysiology tests, cerebral blood flow, substrate delivery, substrate utilization, and cellular metabolism. Most studies in neuromonitoring have focused on traumatic brain injury, with a paucity of data on other clinical types of acute brain injury. We provide a concise summary of the most commonly used invasive and noninvasive neuromonitoring techniques, their associated risks, their bedside clinical application, and the implications of common findings to guide evaluation and management of critically ill patients. CONCLUSIONS: Neuromonitoring techniques provide an essential tool to facilitate early detection and treatment of acute brain injury in critical care. Awareness of the nuances of their use and clinical applications can empower the intensive care team with tools to potentially reduce the burden of neurologic morbidity in critically ill patients.

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“…No previous study has explored the potential clinical use of pupillometry in patients with nonconvulsive status epilepticus (NCSE). In "Automated Pupillometry for Assessment of Treatment Success in Nonconvulsive Status Epilepticus, " Godau et al [2] build on prior work in which they documented both a significant reduction in neurological pupil index (NPi) and a greater difference between left and right NPi in confirmed NCSE [3], this time demonstrating (1) a lower NPi in patients with NCSE and (2) association of both abnormal baseline NPi and normalization of miniNPi with treatment response. This is a single center prospective observational study of 196 NCSE episodes at one medical center, characterizing the pupillary reactivity patterns assessed by use of automated pupillometer.…”

mentioning

confidence: 99%

Pupillometry for Diagnosing Nonconvulsive Status Epilepticus and Assessing Treatment Response?

Hocker

2021

Neurocrit Care

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Automated Pupillometry for Assessment of Treatment Success in Nonconvulsive Status Epilepticus

Cited by 10 publications

References 39 publications

Quantitative assessments of pupillary light reflexes in neurocritically ill patients

Quantitative assessments of pupillary light reflexes in neurocritically ill patients

Neuromonitoring in Critically Ill Patients

Pupillometry for Diagnosing Nonconvulsive Status Epilepticus and Assessing Treatment Response?

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