Upcoming events, books, publications, and other news in the fields of neuromonitoring and neurocritical care.
Neuroscience Monitor
June 2011 Vol. 2 No. 1
In this edition of The Neuroscience Monitor, we highlight upcoming events for the summer of 2011, provide lists of some neuroscience must-reads, and give you some insights from our in-house experts.
New York Symposium on Neurological Emergencies & Neurocritical Care      

Join us June 14th - 17th as Columbia University and New York Presbyterian host the 8th New York Symposium on Neurological Emergencies & Neurocritical Care. The program aims at informing health care practitioners of the latest diagnostic and treatment techniques for patients with acute neurological injury.
New York Symposium of Neurological Emergencies & Neurocritical Care
8th New York Symposium on Neurological
Emergencies & Neurocritical Care
The last day of the event will focus on the topics of continuous EEG and multimodal monitoring. The program highlights the impact of new technologies and pharmacologic interventions that are revolutionizing state-of-the-art care by reducing neurological injury in the emergency room and ICU. Look for our product, the CNS Monitor, to see how we are revolutionizing  multimodal neuromonitoring .

Details on the program for the New York Symposium are available on the event's website.
Upcoming Events for Summer 2011
Federal Interagency Conference on Traumatic Brain Injury in Washington, DC
June 13 - 15

8th New York Symposium on Neurological Emergencies & Neurocritical Care in NYC, New York
June 14 - 17

National Neurotrauma Symposium in Hollywood, Florida
July 10 - 13

VASOSPASM 2011 in Cincinatti, Ohio
July 21 - 23

American Society of Electroneurodiagnostic Technologists 2011 Annual Conference in Atlanta, Georgia
July 27 - 30

9th Annual Neurocritical Care Society Meeting in Montreal, QC, Canada

September 21 -24

Saving the Brain: 4th Annual Neuroscience Symposium in Santa Barbara, California
September 24
Multimodal neuromonitoring in a patient with aneurysmal subarachnoid hemorrhage associated with aortic coarctation.
Helbok R, Beer R, Chemelli A, Sohm F, Broessner G, Lackner P, Sojer M, Pfausler B, Thomé C, Schmutzhard E.
Neurocrit Care. 2011 Jun;14(3):433-7
Neuromonitoring in intensive care: a new brain tissue probe for combined monitoring of intracranial pressure (ICP) cerebral blood flow (CBF) and oxygenation.
Keller E, Froehlich J, Muroi C, Sikorski C, Muser M.
Acta Neurochir Suppl. 2011;110(Pt 2):217-20
Neuromonitoring in intensive care: a new brain tissue probe for combined monitoring of intracranial pressure (ICP) cerebral blood flow (CBF) and oxygenation.
Keller E, Froehlich J, Muroi C, Sikorski C, Muser M.
Acta Neurochir Suppl. 2011;110(Pt 2):217-20
Intracerebral monitoring of silent infarcts after subarachnoid hemorrhage.
Helbok R, Madineni RC, Schmidt MJ, Kurtz P, Fernandez L, Ko SB, Choi A, Stuart MR, Connolly ES, Lee K, Badjatia N, Mayer SA, Khandji AG, Claassen J.
Neurocrit Care. 2011 Apr;14(2):162-7

Traumatic Brain Injury : Advanced Multimodal Neuromonitoring From
Theory to Clinical Practice

Sandy Cecil, Patrick M. Chen, Sarah E. Callaway, Susan M. Rowland, David E. Adler and
Jefferson W. Chen

Crit Care Nurse 2011;31:25-37 doi: 10.4037/ccn2010226
Book Cover Epilepsy and Intensive Care Monitoring: Principles and Practice

Bruce J. Fisch, MD, and Bruce Fisch

Published: September 15, 2009

Book Cover Case Studies in Neuroanesthesia and Neurocritical Care

George A. Mashour and Ehab Farag

Published: December 31, 2010

Book Cover Neurosurgical Emergencies

Christopher M. Loftus

Published: October 22, 2007

Book Cover Neurocritical Care (Cambridge Medicine)

Michel T. Torbey MD

Published: September 14, 2009

Book Cover Decision Making in Neurocritical Care

Jennifer Frontera

Published: April 24, 2009

Book Cover Neurocritical Care: A Guide to Practical Management (Competency-Based Critical Care)

John P. Adams, Dominic Bell, and Justin McKinlay

Published: February 18, 2010

Book Cover Handbook of Neurocritical Care (Current Clinical Neurology)

Anish Bhardwaj and Marek A. Mirski

Published: June 28, 2010

Book Cover Neurotrauma and Critical Care of the Brain

Jack Jallo and Christopher M Loftus

Published: May 28, 2009

Book Cover Essentials of Neurosurgical Anesthesia & Critical Care: Strategies for Prevention, Early Detection, and Successful Management of Perioperative Complications (Lecture Notes in Mathematics; 751)

Ansgar Brambrink and Jeffrey Kirsch

Published: July 1, 2010

Book Cover Handbook of Neurocritical Care

J. Ricardo Carhuapoma and Stephan Mayer

Published: March 1, 2008

Multimodal Neuromonitoring - What's in a Name?
by Dick Moberg, President Moberg Research, Inc.

The term “multimodal neuromonitoring” is frequently used in the literature to describe a particular monitoring paradigm but it has been defined and used in the literature in several ways.  In this short article we will review the history of this concept and propose a definition. 

At face value, multimodal monitoring means monitoring with more than one mode or measurement.  However, few would consider the Glasgow Coma Score multimodal monitoring even though it measures three parameters --  visual, verbal, and motor. Historically, the term, as applied to neuromonitoring, was first used in intraoperative neurophysiological monitoring to indicate the simultaneous use of different evoked potential modes.  A paper from 1990 in Germany talks about the advantages of multimodal monitoring using somatosensory and auditory evoked potentials along with EEG to assess prognosis (Zettler, 1990).  And one of the first reports of simultaneous monitoring of a range of physiology and neurophysiology measurements was published by Hilz, et. al. also in 1990. 

In spite of roots in neurophysiology, multimodal neuromonitoring is most frequently used to mean monitoring “something in addition to ICP”.  Intracranial pressure was perhaps the first continuously monitored neuro measurement that was routinely recorded.  Its history spans back to the 1950’s with use in neurosurgery becoming routine in the 1970’s.  In the early to mid-1990s reports were published that showed the utility of continuously monitoring other measurements in conjunction with the ICP.  In 1994 Marek Czosnyka and Peter Smielewski reported on their multimodal bedside computer system that monitored ICP, ABP, laser Doppler blood flow, MCA flow velocity (via TCD), SjvO2, and NIRS-based cortical haemoglobin.  Most papers in neurocritical care since the early 1990s using the term multimodal neuromonitoring refer to some combination of ICP and another measurement. 

Returning to the term multimodal neuromonitoring, we can start the definition as a combination of the terms.  Multimodal neuromonitoring refers to monitoring more than one measurement (muiltimodal) for use in the management of the patient or the detection of harmful events before they can cause irreversible damage to the brain (neuromonitoring).   There are some nuances that can be added to this simplistic definition.  The first concerns which modalities are monitored.  Preferably the choice of measurements is application oriented and goal directed; that is, we are monitoring to detect specific events for the type of patient at hand.  It is also assumes that each additional measurement adds to the sensitivity or specificity of the detection.  Another criterion is that the recordings are in real-time or performed frequently enough to be used in “monitoring” rather than post hoc evaluation.  Finally there needs to be an adequate degree of time synchronization in the data and simultaneous display to see correlations. 

So here is my definition:
Multimodality monitoring is the simultaneous collection of data from multiple diverse sources each contributing uniquely to a patient’s monitoring goals coupled with the ability to view the data in an integrated and time synchronized manner. 
I am open to comments.

Zettler H, Kursawe HK.  Brain function monitoring.  Anaesthesiol Reanim. 1990;15(3):151-9
Hilz M,  Litscher G, et al  Continuous multivariable monitoring in neurological intensive care patients - preliminary reports on four cases.  Intensive Care Med 1991:17:87-93
Czosnyka M, Whitehouse H, Smielewski P, Kirkpatrick P, Guazzo EP, Pickard JD. Computer supported multimodal bed-side monitoring for neuro intensive care. Int J Clin Monit Comput 1994;11:223-32.

Copyright © 2011, Moberg Research, Inc.
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