Download PDF
Klinische Neurophysiologie 2016; 47(04): 194-199
DOI: 10.1055/s-0042-101219
Originalia
© Georg Thieme Verlag KG Stuttgart · New York

Klinisch-neurophysiologische Diagnostik in der Neurorehabilitation

Clinical Neurophysiological Examinations in Neurological Rehabilitation
J. D. Rollnik
1   Institut für neurorehabilitative Forschung (InFo) der BDH-Klinik Hessisch Oldendorf gGmbH, Assoziiertes Institut der Medizinischen Hochschule Hannover (MHH)
› Author Affiliations
Further Information

Publication History

Publication Date:
20 April 2016 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Klinisch-neurophysiologische Methoden, insbesondere die Elektroenzephalografie (EEG) und multimodal evozierte Potenziale (EP) werden in der Akutmedizin zur Diagnostik, aber auch zur Prognoseeinschätzung eingesetzt. Das vorliegende Review gibt einen Überblick darüber, inwiefern diese Verfahren auch eine Bedeutung für prognostische Aussagen und Entscheidungen in der neurologischen Rehabilitation haben, v. a. der neurologisch-neurochirurgischen Frührehabilitation. Die vorliegende Literatur zeigt, dass ein langsamer Grundrhythmus im EEG ebenso mit einem ungünstigen Langzeit-Behandlungsergebnis verbunden ist wie Auffälligkeiten in den EP (z. B. ein Ausfall kortikaler Antworten). Zusammen mit klinischen Parametern und bildgebenden Befunden erlauben klinisch-neurophysiologische Techniken eine Verbesserung prognostischer Aussagen in der Neurorehabilitation.

Abstract

Clinical neurophysiological techniques such as electroencephalography (EEG) and evoked potentials (EP) are used in acute-care hospitals for diagnostic and prognostic reasons. This paper reviews the use of these methods to predict outcome in neurorehabilitation, in particular neurological early rehabilitation. Literature suggests that slow EEG rhythms as well as EP abnormalities (e. g. loss of cortical EP) are associated with poor long-term outcome. Together with clinical and neuroimaging data, clinical neurophysiology enables improved outcome prediction in neurological rehabilitation.

Schlüsselwörter

Neurorehabilitation - Frührehabilitation - Neurophysiologie - EEG - EP

Key words

neurorehabilitation - early rehabilitation - neurophysiology - EEG - EP
 

  • Literatur

  • 1 Foerch C, Misselwitz B, Sitzer M et al. Hesse Stroke Study Group . The projected burden of stroke in the German federal state of Hesse up to the year 2050. Dtsch Arztebl Int 2008; 105: 467-473
    PubMedSearch in Google Scholar
  • 2 Rollnik JD, Janosch U. Current trends in the length of stay in neurological early rehabilitation. Dtsch Arztebl Int 2010; 107: 286-292
    PubMedSearch in Google Scholar
  • 3 Rollnik JD, Platz T, Böhm KD et al. Argumente für eine Zuordnung der neurologisch-neurochirurgischen Frührehabilitation (Phase B) zum Krankenhausbereich (§+39 SGB V). Positionspapier der Kliniken des BDH Bundesverband Rehabilitation. Akt Neurol 2011; 38: 362-368
    Thieme ConnectPubMedSearch in Google Scholar
  • 4 Rollnik JD, Altenmüller E. Music in disorders of consciousness. Front Neurosci 2014; 8: 190
    PubMedSearch in Google Scholar
  • 5 Rollnik JD, Samady M, Grüter L. Multiresistente Erreger in der neurologisch-neurochirurgischen Frührehabilitation (2004-2013). Rehabilitation (Stuttg) 2014; 53: 346-350
    Thieme ConnectPubMedSearch in Google Scholar
  • 6 Rollnik JD. Outcome of MRSA carriers in neurological early rehabilitation. BMC Neurology 2014; 14: 34
    CrossrefPubMedSearch in Google Scholar
  • 7 Rollnik JD. Outcome of neurological early rehabilitation patients colonized with extended-spectrum beta-lactamase (ESBL) producing bacteria. Open Journal of Therapy and Rehabilitation 2015; 3: 1-8
    CrossrefPubMedSearch in Google Scholar
  • 8 Pohl M, Bertram M, Bucka C et al. Rehabilitationsverlauf von Patienten in der neurologisch-neurochirurgischen Frührehabilitation: Ergebnisse einer multizentrischen Erfassung im Jahr 2014 in Deutschland. Nervenarzt 2016 (in Druck)
    PubMed
  • 9 Rollnik JD. Grundlagen der Palliativmedizin und Prognosestellung. In: Rollnik JD. (Hrsg.) Die neurologisch-neurochirurgische Frührehabilitation. Die neurologisch-neurochirurgische Frührehabilitation. Springer; Heidelberg: 2013: 365-370
    CrossrefSearch in Google Scholar
  • 10 Kissela B, Lindsell CJ, Kleindorfer D et al. Clinical prediction of functional outcome after ischemic stroke: the surprising importance of periventricular white matter disease and race. Stroke 2009; 40: 530-536
    CrossrefPubMedSearch in Google Scholar
  • 11 Basile AM, Di Carlo A, Lamassa M et al. European BIOMED Study of Stroke Care Group . Selective risk factors profiles and outcomes among patients with stroke and history of prior myocardial infarction. The European Community Stroke Project. J Neurol Sci 2008; 264: 87-92
    CrossrefPubMedSearch in Google Scholar
  • 12 Nakayama H, Jørgensen HS, Raaschou HO et al. The influence of age on stroke outcome. The Copenhagen Stroke Study. Stroke 1994; 25: 808-813
    CrossrefPubMedSearch in Google Scholar
  • 13 Rollnik JD. Der Barthel-Index als Verweildauerprädiktor in der neurologischen Rehabilitation. Rehabilitation (Stuttg) 2009; 48: 91-94
    Thieme ConnectPubMedSearch in Google Scholar
  • 14 Wagle J, Farner L, Flekkøy K et al. Early post-stroke cognition in stroke rehabilitation patients predicts functional outcome at 13 months. Dement Geriatr Cogn Disord 2011; 31: 379-387
    CrossrefPubMedSearch in Google Scholar
  • 15 Viken JI, Samuelsson H, Jern C et al. The prediction of functional dependency by lateralized and non-lateralized neglect in a large prospective stroke sample. Eur J Neurol 2012; 19: 128-134
    CrossrefPubMedSearch in Google Scholar
  • 16 Paolucci S, Antonucci G, Grasso MG et al. Post-stroke depression, antidepressant treatment and rehabilitation results. A case-control study. Cerebrovasc Dis 2001; 12: 264-271
    CrossrefPubMedSearch in Google Scholar
  • 17 Bilge C, Koçer E, Koçer A et al. Depression and functional outcome after stroke: the effect of antidepressant therapy on functional recovery. Eur J Phys Rehabil Med 2008; 44: 13-18
    PubMedSearch in Google Scholar
  • 18 Samanci N, Dora B, Kizilay F et al. Factors affecting one year mortality and functional outcome after first ever ischemic stroke in the region of Antalya, Turkey (a hospital-based study). Acta Neurol Belg 2004; 104: 154-160
    PubMedSearch in Google Scholar
  • 19 Lenze EJ, Munin MC, Quear T et al. Significance of poor patient participation in physical and occupational therapy for functional outcome and length of stay. Arch Phys Med Rehabil 2004; 85: 1599-1601
    CrossrefPubMedSearch in Google Scholar
  • 20 Musicco M, Emberti L, Nappi G et al. Italian Multicenter Study on Outcomes of Rehabilitation of Neurological Patients. Early and long-term outcome of rehabilitation in stroke patients: the role of patient characteristics, time of initiation, and duration of interventions. Arch Phys Med Rehabil 2003; 84: 551-558
    CrossrefPubMedSearch in Google Scholar
  • 21 Frank M, Conzelmann M, Engelter S. Prediction of discharge destination after neurological rehabilitation in stroke patients. Eur Neurol 2010; 63: 227-233
    CrossrefPubMedSearch in Google Scholar
  • 22 Zeman BD, Yiannikas C. Functional prognosis in stroke: use of somatosensory evoked potentials. J Neurol Neurosurg Psychiatry 1989; 52: 242-247
    CrossrefPubMedSearch in Google Scholar
  • 23 Kovala T. Prognostic significance of somatosensory potentials evoked by stimulation of the median and posterior tibial nerves: a prospective 1-year follow-up study in patients with supratentorial cerebral infarction. Eur Neurol 1991; 31: 141-148
    CrossrefPubMedSearch in Google Scholar
  • 24 Cillessen JP, van Huffelen AC, Kappelle LJ et al. Electroencephalography improves the prediction of functional outcome in the acute stage of cerebral ischemia. Stroke 1994; 25: 1968-1972
    CrossrefPubMedSearch in Google Scholar
  • 25 Ring H, Bar L, Abboud S. Functional correlates with left-right asymmetry of visual evoked potentials in stroke patients: modeling and experimental results. Arch Phys Med Rehabil 1999; 80: 166-172
    CrossrefPubMedSearch in Google Scholar
  • 26 Feys H, Van Hees J, Bruyninckx F et al. Value of somatosensory and motor evoked potentials in predicting arm recovery after a stroke. J Neurol Neurosurg Psychiatry 2000; 68: 323-331
    CrossrefPubMedSearch in Google Scholar
  • 27 Steube D, Wiethölter S, Correll C. Prognostic value of lower limb motor evoked potentials for motor impairment and disability after 8 weeks of stroke rehabilitation – a prospective investigation of 100 patients. Electromyogr Clin Neurophysiol 2001; 41: 463-469
    PubMedSearch in Google Scholar
  • 28 Tzvetanov P, Rousseff RT. Median SSEP changes in hemiplegic stroke: long-term predictive values regarding ADL recovery. NeuroRehabilitation 2003; 18: 317-324
    CrossrefPubMedSearch in Google Scholar
  • 29 Tzvetanov P, Rousseff RT, Milanov I. Lower limb SSEP changes in stroke-predictive values regarding functional recovery. Clin Neurol Neurosurg 2003; 105: 121-127
    CrossrefPubMedSearch in Google Scholar
  • 30 Tzvetanov P, Rousseff RT, Atanassova P. Prognostic value of median and tibial somatosensory evoked potentials in acute stroke. Neurosci Lett 2005; 380: 99-104
    CrossrefPubMedSearch in Google Scholar
  • 31 Al-Rawi MA, Hamdan FB, Abdul-Muttalib AK. Somatosensory evoked potentials as a predictor for functional recovery of the upper limb in patients with stroke. J Stroke Cerebrovasc Dis 2009; 18: 262-268
    CrossrefPubMedSearch in Google Scholar
  • 32 Pizzi A, Carrai R, Falsini C et al. Prognostic value of motor evoked potentials in motor function recovery of upper limb after stroke. J Rehabil Med 2009; 41: 654-660
    CrossrefPubMedSearch in Google Scholar
  • 33 Gobiet W, Gobiet R. Frührehabilitation nach Schädel-Hirn-Trauma. Berlin: Springer Verlag; 1999
    CrossrefSearch in Google Scholar
  • 34 Oder W. Prognosefaktoren des schweren Schädel-Hirn-Traumas. J Neurol Neurochir Psychiatr 2004; 5: 7-22
    PubMedSearch in Google Scholar
  • 35 Katz DI. Neuropathology and neurobehavioral recovery from closed head injury. Joumal of Head Trauma Rehabilitation 1992; 7: 1-15
    PubMedSearch in Google Scholar
  • 36 Mackey-Hargadine JR, Hall 3rd JW. Sensory evoked responses in head injury. Cent Nerv Syst Trauma 1985; 2: 187-206
    PubMedSearch in Google Scholar
  • 37 Shin DY, Ehrenberg B, Whyte J et al. Evoked potential assessment: utility in prognosis of chronic head injury. Arch Phys Med Rehabil 1989; 70: 189-193
    PubMedSearch in Google Scholar
  • 38 Thatcher RW, Cantor DS, McAlaster R et al. Comprehensive predictions of outcome in closed head-injured patients. The development of prognostic equations. Ann N Y Acad Sci 1991; 620: 82-101
    CrossrefPubMedSearch in Google Scholar
  • 39 Mazzini L, Pisano F, Zaccala M et al. Somatosensory and motor evoked potentials at different stages of recovery from severe traumatic brain injury. Arch Phys Med Rehabil 1999; 80: 33-39
    CrossrefPubMedSearch in Google Scholar
  • 40 Özbudak-Demir S, Akyüz M, Güler-Uysal F et al. Postacute predictors of functional and cognitive progress in traumatic brain injury: somatosensory evoked potentials. Arch Phys Med Rehabil 1999; 80: 252-257
    CrossrefPubMedSearch in Google Scholar
  • 41 Lew HL, Dikmen S, Slimp J et al. Use of somatosensory-evoked potentials and cognitive event-related potentials in predicting outcomes of patients with severe traumatic brain injury. Am J Phys Med Rehabil 2003; 82: 53-61
    CrossrefPubMedSearch in Google Scholar
  • 42 Houlden DA, Taylor AB, Feinstein A et al. Early somatosensory evoked potential grades in comatose traumatic brain injury patients predict cognitive and functional outcome. Crit Care Med 2010; 38: 167-174
    CrossrefPubMedSearch in Google Scholar
  • 43 Hagel K, Rietz S. Die Prognose des apallischen Syndroms. Anaesthesist 1998; 47: 677-682
    CrossrefPubMedSearch in Google Scholar
  • 44 Zeitlhofer J, Steiner M, Oder W et al. The prognostic value of evoked potentials in early neurologic rehabilitation of patients with the apallic syndrome. EEG EMG Z Elektroenzephalogr Elektromyogr Verwandte Geb 1991; 22: 10-14
    PubMedSearch in Google Scholar
  • 45 Goldberg G, Karazim E. Application of evoked potentials to the prediction of discharge status in minimally responsive patients: a pilot study. J Head Trauma Rehabil 1998; 13: 51-68
    CrossrefPubMedSearch in Google Scholar
  • 46 Howell K, Grill E, Klein AM et al. Rehabilitation outcome of anoxic-ischaemic encephalopathy survivors with prolonged disorders of consciousness. Resuscitation 2013; 84: 1409-1415
    CrossrefPubMedSearch in Google Scholar
  • 47 Schorl M, Valerius-Kukula SJ, Kemmer TP. Median-evoked somatosensory potentials in severe brain injury: does initial loss of cortical potentials exclude recovery?. Clin Neurol Neurosurg 2014; 123: 25-33
    CrossrefPubMedSearch in Google Scholar
  • 48 Bagnato S, Boccagni C, Sant'Angelo A et al. EEG predictors of outcome in patients with disorders of consciousness admitted for intensive rehabilitation. Clin Neurophysiol 2015; 126: 959-966
    CrossrefPubMedSearch in Google Scholar
  • 49 Heinz U, Rollnik JD. Outcome of hypoxic brain damage patients undergoing neurological early rehabilitation. BMC Res Notes 2015; 8: 243
    CrossrefPubMedSearch in Google Scholar
  • 50 Müller C, Glässel A. Die ICF als konzeptioneller Bezugsrahmen für die Teamkonferenz. Neuro Rehabil 2008; 14: 265-174
    PubMedSearch in Google Scholar
  • 51 Rollnik JD. Das Hessisch Oldendorfer ICF-Assessment (HOIA) – ein Vorschlag zur Befundung, Zielfindung und Dokumentation der Zielerreichung in der neurologisch-neurochirurgischen Rehabilitation. Akt Neurol 2014; 41: 328-334
    Thieme ConnectPubMedSearch in Google Scholar
  • 52 Hankemeier A, Rollnik JD. The Early Functional Abilities (EFA) scale to assess neurological and neurosurgical early rehabilitation patients. BMC Neurology 2015; 15: 207
    CrossrefPubMedSearch in Google Scholar
  • 53 Rollnik JD. May clinical neurophysiology help to predict the recovery of neurological early rehabilitation patients?. BMC Neurology 2015; 15: 239
    CrossrefPubMedSearch in Google Scholar