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Abstract
Background and Objectives To investigate the frequency of induced EEG burst suppression pattern during continuous IV anesthesia (IVAD) and associated outcomes in adult patients treated for refractory status epilepticus (RSE).
Methods Patients with RSE treated with anesthetics at a Swiss academic care center from 2011 to 2019 were included. Clinical data and semiquantitative EEG analyses were assessed. Burst suppression was categorized as incomplete burst suppression (with ≥20% and <50% suppression proportion) or complete burst suppression (with ≥50% suppression proportion). The frequency of induced burst suppression and association of burst suppression with outcomes (persistent seizure termination, in-hospital survival, and return to premorbid neurologic function) were the endpoints.
Results We identified 147 patients with RSE treated with IVAD. Among 102 patients without cerebral anoxia, incomplete burst suppression was achieved in 14 (14%) with a median of 23 hours (interquartile range [IQR] 1–29) and complete burst suppression was achieved in 21 (21%) with a median of 51 hours (IQR 16–104). Age, Charlson comorbidity index, RSE with motor symptoms, the Status Epilepticus Severity Score and arterial hypotension requiring vasopressors were identified as potential confounders in univariable comparisons between patients with and without any burst suppression. Multivariable analyses revealed no associations between any burst suppression and the predefined endpoints. However, among 45 patients with cerebral anoxia, induced burst suppression was associated with persistent seizure termination (72% without vs 29% with burst suppression, p = 0.004) and survival (50% vs 14% p = 0.005).
Discussion In adult patients with RSE treated with IVAD, burst suppression with ≥50% suppression proportion was achieved in every fifth patient and not associated with persistent seizure termination, in-hospital survival, or return to premorbid neurologic function.
Glossary
- ABI=
- anoxic brain injury;
- ACNS=
- American Clinical Neurophysiology Society;
- cEEG=
- continuous EEG;
- GCS=
- Glasgow Coma Score;
- GOS=
- Glasgow Outcome Scale;
- ICU=
- intensive care unit;
- IQR=
- interquartile range;
- IVAD=
- IV administration of anesthetic drug;
- RSE=
- refractory status epilepticus;
- SE=
- status epilepticus;
- STESS=
- Status Epilepticus Severity Score
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Submitted and externally peer reviewed. The handling editor was Associate Editor Barbara Jobst, MD, PhD, FAAN.
See page 889
- Received August 1, 2022.
- Accepted in final form January 17, 2023.
- © 2023 American Academy of Neurology
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- Author Response: Association Between Induced Burst-Suppression and Clinical Outcomes in Patients With Refractory Status Epilepticus: A 9-Year Cohort Study
- Reader Response: Association Between Induced Burst-Suppression and Clinical Outcomes in Patients With Refractory Status Epilepticus: A 9-Year Cohort Study
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