Electrographic Characteristics of Burst Suppression Associated with Seizure Recurrence in Patients with Status Epilepticus
Abstract number :
1.476
Submission category :
3. Neurophysiology / 3B. ICU EEG
Year :
2022
Submission ID :
2232953
Source :
www.aesnet.org
Presentation date :
12/3/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:28 AM
Authors :
Kelly Pu, – Yale University School of Medicine; Michael W.K. Fong, MBBS – Yale University School of Medicine, University of Sydney; Tasleema Khan, MD – Yale University School of Medicine, University of Maryland; Rakesh Jadav, MD – Yale University School of Medicine; Lawrence Hirsch, MD – Yale University School of Medicine; Hitten Zaveri, PhD – Yale University School of Medicine
This is a Late Breaking abstract
Rationale: Burst suppression is an EEG pattern that is often reached following the administration of highly sedating anti-seizure medications (ASM) in the treatment of status epilepticus (SE). For these patients, it is desirable to be able to predict those where seizures would recur if sedative medications were weaned. This study interrogated burst suppression patterns with quantitative measures to evaluate whether any characteristics of the pattern could predict seizure recurrence and, importantly, determine the relative weighting of each of these characteristics.
Methods: Retrospective assessment of patients at Yale New Haven Hospital between 2014 to 2020 with refractory SE where burst suppression was achieved. Following achievement of burst suppression, patients underwent a planned wean of highly sedating ASM. Seizure recurrence at 24 and 48 hours following weaning ASM was the primary outcome. For each EEG record, 50 consecutive bursts were marked by a reader with specific training in ICU EEG. These bursts and suppressions were then analyzed for amplitude, duration, and spectral content.
Results: Twenty-seven patients met the inclusion criteria. Two patients had multiple attempts at medication wean separated by more than 48 hours, resulting in 31 instances. 15 instances were associated with seizure recurrence and 16 instances were not.In this study, the absolute averages of amplitude, duration, power, and complexity for bursts and suppressions did not differ between patients with and without seizure recurrence (Table 1). The greatest determinant of seizure recurrence was evolution within the burst (Figure 1). Total spectral power increased by 38.3% over the burst for instances associated with seizure recurrence compared to a 14.3% decrease in those that did not (p < 0.01). This was also true for Teager energy (a measure of epileptogenicity) (5.8% vs. -12.8%, p< 0.01), delta power (72.9% vs. -4.4%, p< 0.01), and theta power (55.2% vs. 0.8%, p< 0.05).
Conclusions: In the cohort of patients with SE that achieved burst suppression, evolution within the bursts was the greatest predictor of seizure recurrence at 48 hours. In this study, highly epileptiform bursts were of better predictive value for seizure recurrence than total amplitude, duration, or power alone. Thus, the evolution of burst suppression patterns may have value in informing treatment of patients with status epilepticus.
Funding: None
Neurophysiology