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Dr. Matthew Banks
Department of Neuroscience, Department of Anesthesiology
Intracranial electrophysiological signatures of post-operative and post-ictal delirium
Post-operative and post-ictal delirium (POD, PID) are acute disorders of consciousness characterized by confusion, fluctuating arousal, impaired executive function, and perceptual disturbances. POD is a harbinger of dementia and accelerated age-associated cognitive decline. PID is a significant health concern in epilepsy and is a common complication of electroconvulsive therapy. Thus, delirium is a major public health problem, yet its pathophysiology is poorly understood. The mechanisms underlying delirium and the degree to which these mechanisms overlap between POD and PID are unknown. Epilepsy patients undergoing intracranial electroencephalographic (iEEG) monitoring prior to surgery for resection of seizure foci can experience both POD and PID, and thus are suitable subjects for mechanistic investigations. Network models suggest that the symptoms of delirium are secondary to disruptions in information flow within and between canonical brain networks. Delirium-related changes in cortical activity and connectivity overlap with those of sleep and anesthesia (e.g., disrupted fronto-parietal connectivity), even though patients remain conscious. I will present initial observations on changes in neural activity and connectivity assayed from iEEG recordings in patients experiencing POD and PID.