Electroencephalography for monitoring cortical electrical activity related to intracranial pressure in patients with traumatic brain injury: a systematic review.

Intracranial pressure (ICP) driven treatment of patients with traumatic brain injury (TBI) in the Intensive Care Unit (ICU) remains a continuous challenge. Patients are sedated and therapy focuses on preventing secondary injury caused by an increase in ICP and reduction of cerebral blood flow (CBF). While ICP-monitoring provides valuable information on secondary deterioration, it offers limited insight into the complex and dynamic intracranial processes following TBI and carries the risk of complications (hemorrhage, infections). Integration of noninvasive advanced monitoring modalities to understand this process is mandatory. Electroencephalography (EEG) monitoring provides an advanced noninvasive method to measure focal cerebral electrical activity in real-time and is particularly sensitive to cortical oxygen and metabolic deficits. Investigations of the relationship between disruptions in EEG patterns and traditional invasive ICP measurements could provide valuable insights into the pathophysiology of intracranial hypertension and may pave the way for using continuous EEG in future ICP management. To date, no systematic review has evaluated the relationship between EEG and ICP in adult patients with TBI. This systematic review was conducted according to the PRISMA-guidelines. Three studies specifically reported on the incidence of post-traumatic seizures and ICP, and one study reported on a directional relationship between EEG activity and ICP. Altogether, there is a paucity of evidence and studies investigating the relationship between EEG and ICP. This highlights the need for systematic, well-powered research to clarify their interplay and underlying pathophysiology.