Annals of Clinical Neurophysiology

The Korean Society of Clinical Neurophysiology (대한임상신경생리학회)
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Electroencephalography for the diagnosis of brain death

  • Lee, Seo-Young (Department of Neurology, Kangwon National University School of Medicine) ;
  • Kim, Won-Joo (Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Kim, Jae Moon (Department of Neurology, Chungnam National University Hospital) ;
  • Kim, Juhan (Department of Neurology, Hanyang University Seoul Hospital) ;
  • Park, Soochul (Department of Neurology, Yonsei University College of Medicine) ;
  • Korean Society of Clinical Neurophysiology Education Committee (Korean Society of Clinical Neurophysiology)
  • Received : 2017.04.27
  • Accepted : 2017.06.07
  • Published : 2017.07.31
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Abstract

Electroencephalography (EEG) is frequently used to assist the diagnosis of brain death. However, to date there have been no guidelines in terms of EEG criteria for determining brain death in Korea, despite EEG being mandatory. The purpose of this review is to provide an update on the evidence and controversies with regarding to the utilization of EEG for determining brain death and to serve as a cornerstone for the development of future guidelines. To determine brain death, electrocerebral inactivity (ECI) should be demonstrated on EEG at a sensitivity of $2{\mu}V/mm$ using double-distance electrodes spaced 10 centimeters or more apart from each other for at least 30 minutes, with intense somatosensory or audiovisual stimuli. ECI should be also verified by checking the integrity of the system. Additional monitoring is needed if extracerebral potentials cannot be eliminated. Interpreting EEG at high sensitivities, which is required for the diagnosis of brain death, can pose a diagnostic challenge. Furthermore, EEG is affected by physiologic variables and drugs. However, no consensus exists as to the minimal requirements for blood pressure, oxygen saturation, and body temperature during the EEG recording itself, the minimal time for observation after the brain injury or rewarming from hypothermia, and how to determine brain death when the findings of ECI is equivocal. Therefore, there is a strong need to establish detailed guidelines for performing EEG to determine brain death.

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