$Quantitative burst suppression on serial intermittent EEG in refractory status epilepticus$
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Quantitative burst suppression on serial intermittent EEG in refractory status epilepticus

Objectives: In refractory status epilepticus (RSE), the optimal degree of suppression (EEG burst suppression or merely suppressing seizures) remains unknown. Many centers lacking continuous EEG must default to serial intermittent recordings where uncertainty from lack of data may prompt more aggress...

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Autores principales:	Joseph Peedicail, Neil Mehdiratta, Shenghua Zhu, Paulina Nedjadrasul, Marcus C. Ng
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Refractory status epilepticus Seizure Burst suppression Intensive care unit Quantitative EEG Serial intermittent monitoring Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571
Acceso en línea:	https://doaj.org/article/235f80139baf48b694eec69a16f289b0
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spelling	oai:doaj.org-article:235f80139baf48b694eec69a16f289b02021-11-18T04:50:54ZQuantitative burst suppression on serial intermittent EEG in refractory status epilepticus2467-981X10.1016/j.cnp.2021.10.003https://doaj.org/article/235f80139baf48b694eec69a16f289b02021-01-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2467981X21000457https://doaj.org/toc/2467-981XObjectives: In refractory status epilepticus (RSE), the optimal degree of suppression (EEG burst suppression or merely suppressing seizures) remains unknown. Many centers lacking continuous EEG must default to serial intermittent recordings where uncertainty from lack of data may prompt more aggressive suppression. In this study, we sought to determine whether the quantitative burst suppression ratio (QBSR) from serial intermittent EEG recording is associated with RSE patient outcome. Methods: We screened the EEG database to identify non-anoxic adult RSE patients for EEG and chart review. QBSR was calculated per 10-second EEG epoch as the percentage of time during which EEG amplitude was <3 µV. Patients who survived 1–3 months after discharge from ICU and hospital comprised the favorable group. Further to initial unadjusted univariate analysis of all pooled QBSR, we conducted multivariate analyses to account for individual patient confounders (“per-capita analysis”), uneven number of EEG recordings (“per-session analysis”), and uneven number of epochs (“per-epoch analysis”). We analyzed gender, anesthetic number, and adjusted status epilepticus severity score (aSTESS) as confounders. Results: In 135,765 QBSR values over 160 EEG recordings (median 2.17 h every ≥24 h) from 17 patients on Propofol, Midazolam, and/or Ketamine, QBSR was deeper in the favorable group (p < 0.001) on initial unadjusted analysis. However, on adjusted multivariate analysis, there was consistently no association between QBSR and outcome. Higher aSTESS consistently associated with unfavorable outcome on per-capita (p = 0.033), per-session (p = 0.048) and per-epoch (p < 0.001) analyses. Greater maximal number of non-barbiturate anesthetic associated with favorable outcome on per-epoch analysis (p < 0.001). Conclusions: There was no association between depth of EEG suppression using non-barbiturate anesthetic and RSE patient outcome based on QBSR from serial intermittent EEG. A per-epoch association between non-barbiturate anesthetic and favorable outcome suggests an effect from non-suppressive time-varying EEG content. Significance: Targeting and following deeper burst suppression through non-barbiturate anesthetics on serial intermittent EEG monitoring of RSE is of limited utility.Joseph PeedicailNeil MehdirattaShenghua ZhuPaulina NedjadrasulMarcus C. NgElsevierarticleRefractory status epilepticusSeizureBurst suppressionIntensive care unitQuantitative EEGSerial intermittent monitoringNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571ENClinical Neurophysiology Practice, Vol 6, Iss , Pp 275-280 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Refractory status epilepticus Seizure Burst suppression Intensive care unit Quantitative EEG Serial intermittent monitoring Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571
spellingShingle	Refractory status epilepticus Seizure Burst suppression Intensive care unit Quantitative EEG Serial intermittent monitoring Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Joseph Peedicail Neil Mehdiratta Shenghua Zhu Paulina Nedjadrasul Marcus C. Ng Quantitative burst suppression on serial intermittent EEG in refractory status epilepticus
description	Objectives: In refractory status epilepticus (RSE), the optimal degree of suppression (EEG burst suppression or merely suppressing seizures) remains unknown. Many centers lacking continuous EEG must default to serial intermittent recordings where uncertainty from lack of data may prompt more aggressive suppression. In this study, we sought to determine whether the quantitative burst suppression ratio (QBSR) from serial intermittent EEG recording is associated with RSE patient outcome. Methods: We screened the EEG database to identify non-anoxic adult RSE patients for EEG and chart review. QBSR was calculated per 10-second EEG epoch as the percentage of time during which EEG amplitude was <3 µV. Patients who survived 1–3 months after discharge from ICU and hospital comprised the favorable group. Further to initial unadjusted univariate analysis of all pooled QBSR, we conducted multivariate analyses to account for individual patient confounders (“per-capita analysis”), uneven number of EEG recordings (“per-session analysis”), and uneven number of epochs (“per-epoch analysis”). We analyzed gender, anesthetic number, and adjusted status epilepticus severity score (aSTESS) as confounders. Results: In 135,765 QBSR values over 160 EEG recordings (median 2.17 h every ≥24 h) from 17 patients on Propofol, Midazolam, and/or Ketamine, QBSR was deeper in the favorable group (p < 0.001) on initial unadjusted analysis. However, on adjusted multivariate analysis, there was consistently no association between QBSR and outcome. Higher aSTESS consistently associated with unfavorable outcome on per-capita (p = 0.033), per-session (p = 0.048) and per-epoch (p < 0.001) analyses. Greater maximal number of non-barbiturate anesthetic associated with favorable outcome on per-epoch analysis (p < 0.001). Conclusions: There was no association between depth of EEG suppression using non-barbiturate anesthetic and RSE patient outcome based on QBSR from serial intermittent EEG. A per-epoch association between non-barbiturate anesthetic and favorable outcome suggests an effect from non-suppressive time-varying EEG content. Significance: Targeting and following deeper burst suppression through non-barbiturate anesthetics on serial intermittent EEG monitoring of RSE is of limited utility.
format	article
author	Joseph Peedicail Neil Mehdiratta Shenghua Zhu Paulina Nedjadrasul Marcus C. Ng
author_facet	Joseph Peedicail Neil Mehdiratta Shenghua Zhu Paulina Nedjadrasul Marcus C. Ng
author_sort	Joseph Peedicail
title	Quantitative burst suppression on serial intermittent EEG in refractory status epilepticus
title_short	Quantitative burst suppression on serial intermittent EEG in refractory status epilepticus
title_full	Quantitative burst suppression on serial intermittent EEG in refractory status epilepticus
title_fullStr	Quantitative burst suppression on serial intermittent EEG in refractory status epilepticus
title_full_unstemmed	Quantitative burst suppression on serial intermittent EEG in refractory status epilepticus
title_sort	quantitative burst suppression on serial intermittent eeg in refractory status epilepticus
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/235f80139baf48b694eec69a16f289b0
work_keys_str_mv	AT josephpeedicail quantitativeburstsuppressiononserialintermittenteeginrefractorystatusepilepticus AT neilmehdiratta quantitativeburstsuppressiononserialintermittenteeginrefractorystatusepilepticus AT shenghuazhu quantitativeburstsuppressiononserialintermittenteeginrefractorystatusepilepticus AT paulinanedjadrasul quantitativeburstsuppressiononserialintermittenteeginrefractorystatusepilepticus AT marcuscng quantitativeburstsuppressiononserialintermittenteeginrefractorystatusepilepticus
_version_	1718424962364080128

Quantitative burst suppression on serial intermittent EEG in refractory status epilepticus

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