Hemiplegic Patients With Higher Cortical Dysfunction

Maeshima S, Funahashi K, Itakura T, Komai N, Dohi N. Computed topographic electroencephalo- graphic study in left hemiplegic patients with higher cortical dysfunction. Arch Phys Med Rehabil I994:75: l89- 92. Computed topographic electroencephalography (EEG) was performed on patients with right hemispheric injury due to cerebral infarction to investigate the relationship of wave form pattern with neurologic and neuropsycho- logic data and activities of daily living (ADL). Neurologic signs, unilateral spatial neglect, motor impersistence, and constructional apraxia were found to have no relation to the wave form pattern of computed topographic EEG. In patients with abnormalities detected by the "Mini-Mental State" examination (MMSE) or the "Kana- hiroi" test, and in patients with abnormalities in word fluency, extensive slowing of EEG frequency was commonly observed ipsilateral to the side of the lesion or bilaterally, and the ADL were frequently poor. In contrast, among the patients with slow waves and retained alpha waves. the MMSE, "Kana-hiroi" test, word fluency. and ADL were less abnormal. Computed topographic EEG may thus be a useful tool to evaluate neuropsychological status in rehabilitation patients with cerebral infarction. cc' 1994 by the American Congress qf Rehabilitation Medicine and the American Academy of' Physical Medicine and Rehabilitkion In patients with left hemiplegia due to right hemispheric ir?jury. higher cortical dysfunction including unilateral spa- tial neglect and motor impersistence impedes rehabilitation. Such abnormalities Interfere with both training and activities of daily living (ADL). With the recent development of in- struments for improved neuroradiologic diagnosis. such as the computed tomographic (CT) scan. single photon emis- \ion CT (SPECT) and the positron emission tomographic scan (PET). several studies on localization of the lesions responsible for higher cortical dysfunction have been done. Electrophysiologic studies involving electroencephalogra- phy (EEG). however. are limited in this field. There is an apparent tendency to disregard the utility of EEG testing in stroke patient\. The EEG. however, as a measure of physio- logic operation of the brain. would more likely correlate M.ith behavior and thus may be more useful for assessing and projecting the behavioral impact of the stroke. Computer technology has madc it possible to create a two-dimensional representation of the EEG (computed topographic EEG) that rrpresents the computed equivalent potential for each elec- trode over each frequency band. These techniques have been used to displav the spectral content of the EEG and the scalp distribution oi this content. In this study. computed topographic EEG was performed on stroke patients who had completed a rehabilitation train- ing program to investigate the relationship between EEG findings and neurologic and neul-opsych~)lc,Fical signs. and the level of attainment in ADL.