P.078 Desynchronization in high-definition transcranial direct current stimulation of refractory status epilepticus

Abstract

Background: Recently, we showed cathodal high-definition transcranial direct current stimulation (HD-tDCS) inhibits spikes in refractory status epilepticus (RSE) patients. We sought to characterize relative power changes within regional frequency bands to explore connectivity throughout stimulation. Methods: 28 ICU-EEGs from 10 patients were filtered with 1Hz-lower/127Hz-upper/60Hz-notch. Power spectral density was computed for each individual bipolar-longitudinal (excluding midline) electrode chain in delta/theta/alpha/beta/gamma frequency bands. Relative power was extracted throughout recordings by Welch’s method with 2.5-second Hanning window size with 50% overlap every 10 seconds. The average of relative powers from ≤20-minute pre/during/post stimulation windows were calculated per session/chain/band. Absolute maximal relative power change between pre-during and during-post were computed. ANOVA statistically tested for differences. Results: Change in pre-during for delta/theta/alpha/beta/gamma were respectively -0.7%/-3.1%/-2.8%/-2.1%/8.2%, and during-post were 1.3%/2.8%/2.3%/1.7%/-7%. Positive average changes are increases in average relative power where negative changes show decreases. Changes in absolute maximal average relative power between pre-during and during-post stimulation between frequency bands were significant respectively (p=0.0011, p=0.0139). Conclusions: Relative power in all bands drop pre-during and increase during-post except gamma which correlates with desynchronization being a mechanism for HD-tDCS efficacy in RSE. These frequency band power changes may imply brain connectivity changes that need to be further explored.