Nonconvulsive Status Epilepticus in Patients Suffering Spontaneous Subarachnoid Hemorrhage

Object. Nonconvulsive status epilepticus (NCSE) is an underrecognized and poorly understood complication of aneurysmal subarachnoid hemorrhage (SAH). The authors evaluated the risk factors, electroencephalographic (EEG) characteristics, hospital course, and clinical outcomes associated with NCSE in a population with SAH treated at a single institution. Methods. The hospitalization and outcome data were reviewed in 11 patients who had received a diagnosis of NCSE and SAH. The study included individuals from a cohort of 389 consecutive patients with SAH who were treated between March 2003 and June 2005, and who were analyzed retrospectively. The patients\u27 medical history, neurological grade, events of hospitalization, EEG morphological patterns, and disposition were analyzed. Advanced age, female sex, need for ventriculostomy, poor neurological grade (Hunt and Hess Grade III, IV, or V), thick cisternal blood clots, and structural lesions (intracerebral hemorrhage and stroke) were common in the population with NCSE. Patients with normal results on angiograms, good neurological grade (Hunt and Hess Grade I or II), and minimal SAH (Fisher Grade 1 or 2) were at lower risk. The most common ictal patterns were intermittent, and consisted of generalized periodic epileptiform discharges. Medical complications were also frequent, and the outcome of these patients was poor despite aggressive treatment regimens. Conclusions. Nonconvulsive status epilepticus is a devastating complication of SAH with a high rate of associated morbidity. Based on these findings it appears that the patients at highest risk for NCSE can be identified, and this should provide a basis for further studies designed to determine the clinical significance of various EEG patterns and to develop preventative strategies

Brain-Computer Interfaces and the Protection of the Fundamental Rights of the Vulnerable Persons

The contribution deals with the legal aspects of the brain-computer interfaces (BCI) and, in particular, of those used for the assisted and augmented communication of subjects not able to express themselves with eye-controlled devices. The chapter outlines the constitutional rights involved in the use of BCI, the European discipline applicable to their manufacture and, taking into consideration an Italian case-law, which seems to be extensible to other legal families, wonders the possible legal regime of the personal will expressed through those BCI so to protect vulnerable persons from abuse