Abstract
Objective: To investigate the frequency of induced electroencephalographic (EEG) burst-suppression pattern during continuous intravenous 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 2011-2019 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 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, and the Status Epilepticus Severity Score (STESS) 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).
Conclusions: 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.
- Received August 1, 2022.
- Accepted in final form January 17, 2023.
- © 2023 American Academy of Neurology
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