Here, we present a compelling case of a 19-year-old man who presented to the emergency department with symptoms of GBS that were preceded by an upper respiratory tract infection. Despite initial treatment with IVIg and PLEX, the patient developed profound quadriparesis and respiratory failure. Notably, the patient lost all voluntary movement, becoming totally locked-in. cEEG was used in a nontraditional way as an electrophysiologic communication interface to amplify forehead muscle electrographic signals to enable basic communication. Medical staff and family members were easily able to detect real-time amplification peaks. This allowed them to rapidly begin asking the patient questions and deciphering answers.

Many complex and more invasive ways have been proposed to facilitate communication in locked-in patients [8, 9]. The approach is remarkably simple: using surface EEG electrodes to amplify nonvisible muscle activity. In this case, we targeted the brow region; however, a simple approach could be used for alternative face or body muscles given different patient circumstances (i.e., targeting muscles the patient last lost control of). This electrophysiologic communication interface enabled the patient to communicate his level of pain, anxiety, and shortness of breath, as well as answer yes/no questions posed by the clinical team. It also helped rule out status epilepticus contributing to his lack of responsiveness.

Use of cEEG in this context represents a novel approach to improve the communication challenges faced by severely paralyzed individuals [9]. By amplifying nonvisible muscle activity, this simple electrophysiologic communication interface enabled a patient to communicate effectively with the clinical team, despite being in a total locked-in syndrome. This straight-forward approach uses a technology accessible to most intensive care units and can relatively easily enhance patient autonomy and hospitalized quality of life.