Clinical and Intracranial Electrophysiological Signatures of Post-operative and Post-ictal Delirium

Overview

Journal Clin Neurophysiol

Publisher Elsevier

Date 2025 Jan 25

PMID 39862841

Authors

Matthew I Banks

Emily R Dappen

Elie Matar

Benjamin D Hayum

Michael H Sutherland

Bryan M Krause

Hiroto Kawasaki

Robert D Sanders

Kirill V Nourski

Affiliations

Soon will be listed here.

Abstract

Objectives: (1) Gain insight into the mechanisms of postoperative delirium (POD). (2) Determine mechanistic overlap with post-ictal delirium (PID). Epilepsy patients undergoing intracranial electrophysiological monitoring can experience both POD and PID, and thus are suitable subjects for these investigations.

Methods: POD was assessed daily after surgery. PID was assessed following seizures. Resting state data were collected following delirium assessments, during a control period, and during sleep. Slow-wave activity (SWA: 1-4 Hz) and resting state functional connectivity were compared between different time points and according to delirium status.

Results: POD was present in 6 of 20 participants. Post-operatively, SWA was globally elevated in all participants but highest in POD+ participants. POD+ participants exhibited altered functional connectivity compared to POD-. These differences persisted even after resolution of delirium. PID was present in 7 of 15 participants and was predicted by seizures involving prefrontal cortex. PID+ participants exhibited higher post-ictal SWA versus PID-; no differences in functional connectivity were observed. Post-operative and post-ictal SWA was comparable to sleep in some participants.

Conclusions: Elevated SWA may predispose patients to both post-operative and post-ictal delirium and may indicate overlapping mechanisms.

Significance: Delirium treatments focused on SWA may be most effective for ameliorating cognitive symptoms.

References

Evans J, Nadler J, PreudHomme X, Fang E, Daughtry R, Chapman J . Pilot prospective study of post-surgery sleep and EEG predictors of post-operative delirium. Clin Neurophysiol. 2017; 128(8):1421-1425. DOI: 10.1016/j.clinph.2017.05.004. View

Mannlin J, San Antonio-Arce V, Reinacher P, Scheiwe C, Shah M, Urbach H . Safety profile of subdural and depth electrode implantations in invasive EEG exploration of drug-resistant focal epilepsy. Seizure. 2023; 110:21-27. DOI: 10.1016/j.seizure.2023.05.022. View

Nourski K, Howard 3rd M . Invasive recordings in the human auditory cortex. Handb Clin Neurol. 2015; 129:225-44. DOI: 10.1016/B978-0-444-62630-1.00013-5. View

Tanabe S, Parker M, Lennertz R, Pearce R, Banks M, Sanders R . Reduced Electroencephalogram Complexity in Postoperative Delirium. J Gerontol A Biol Sci Med Sci. 2021; 77(3):502-506. PMC: 8893195. DOI: 10.1093/gerona/glab352. View

Wilson J, Mart M, Cunningham C, Shehabi Y, Girard T, MacLullich A . Delirium. Nat Rev Dis Primers. 2020; 6(1):90. PMC: 9012267. DOI: 10.1038/s41572-020-00223-4. View

Banks M, Krause B, Berger D, Campbell D, Boes A, Bruss J . Functional geometry of auditory cortical resting state networks derived from intracranial electrophysiology. PLoS Biol. 2023; 21(8):e3002239. PMC: 10499207. DOI: 10.1371/journal.pbio.3002239. View

Pottkamper J, Hofmeijer J, van Waarde J, van Putten M . The postictal state - What do we know?. Epilepsia. 2020; 61(6):1045-1061. PMC: 7317965. DOI: 10.1111/epi.16519. View

Kuczmarska A, Ngo L, Guess J, OConnor M, Branford-White L, Palihnich K . Detection of Delirium in Hospitalized Older General Medicine Patients: A Comparison of the 3D-CAM and CAM-ICU. J Gen Intern Med. 2015; 31(3):297-303. PMC: 4762827. DOI: 10.1007/s11606-015-3514-0. View

Watson P, Ceriana P, Fanfulla F . Delirium: is sleep important?. Best Pract Res Clin Anaesthesiol. 2012; 26(3):355-66. PMC: 3808245. DOI: 10.1016/j.bpa.2012.08.005. View

10.

Leslie D, Marcantonio E, Zhang Y, Leo-Summers L, Inouye S . One-year health care costs associated with delirium in the elderly population. Arch Intern Med. 2008; 168(1):27-32. PMC: 4559525. DOI: 10.1001/archinternmed.2007.4. View

11.

Jacobson S, Jerrier H . EEG in delirium. Semin Clin Neuropsychiatry. 2000; 5(2):86-92. DOI: 10.153/SCNP00500086. View

12.

Mattison M . Delirium. Ann Intern Med. 2020; 173(7):ITC49-ITC64. DOI: 10.7326/AITC202010060. View

13.

Kubo T, Sogawa R, Tsuruhashi S, Murakawa-Hirachi T, Matsuoka A, Mizoguchi Y . Risk of delirium with antiepileptic drug use: a study based on the Japanese Adverse Drug Event Report database. Int J Clin Pharm. 2023; 45(5):1260-1266. DOI: 10.1007/s11096-023-01564-2. View

14.

Nir Y, Andrillon T, Marmelshtein A, Suthana N, Cirelli C, Tononi G . Selective neuronal lapses precede human cognitive lapses following sleep deprivation. Nat Med. 2017; 23(12):1474-1480. PMC: 5720899. DOI: 10.1038/nm.4433. View

15.

Privitera M, Kim K . Postictal language function. Epilepsy Behav. 2010; 19(2):140-5. DOI: 10.1016/j.yebeh.2010.06.028. View

16.

Morshed R, Young J, Safaee M, Sankaran S, Berger M, McDermott M . Delirium Risk Factors and Associated Outcomes in a Neurosurgical Cohort: A Case-Control Study. World Neurosurg. 2019; 126:e930-e936. DOI: 10.1016/j.wneu.2019.03.012. View

17.

Bosselmann C, Zurloh J, Stefanou M, Stadler V, Weber Y, Lerche H . Delirium Screening in Aphasic Patients With the Intensive Care Delirium Screening Checklist (ICDSC): A Prospective Cohort Study. Front Neurol. 2019; 10:1198. PMC: 6861445. DOI: 10.3389/fneur.2019.01198. View

18.

Aldecoa C, Bettelli G, Bilotta F, Sanders R, Audisio R, Borozdina A . European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium. Eur J Anaesthesiol. 2017; 34(4):192-214. DOI: 10.1097/EJA.0000000000000594. View

19.

Nir Y, Staba R, Andrillon T, Vyazovskiy V, Cirelli C, Fried I . Regional slow waves and spindles in human sleep. Neuron. 2011; 70(1):153-69. PMC: 3108825. DOI: 10.1016/j.neuron.2011.02.043. View

20.

Thom R, Levy-Carrick N, Bui M, Silbersweig D . Delirium. Am J Psychiatry. 2019; 176(10):785-793. DOI: 10.1176/appi.ajp.2018.18070893. View