Association Between Induced Burst Suppression and Clinical Outcomes in Patients With Refractory Status Epilepticus: A 9-Year Cohort Study
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). Patients with RSE treated with anesthetics at a Swiss academic care center from 2011 to 2019 were in...
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| Veröffentlicht in: | Neurology 2023-05, Vol.100 (19), p.e1955-e1966 |
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| container_end_page | e1966 |
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| container_title | Neurology |
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| creator | Fisch, Urs Jünger, Anja L. Baumann, Sira M. Semmlack, Saskia De Marchis, Gian Marco Hunziker, Sabina Rüegg, Stephan Marsch, Stephan Sutter, Raoul |
| description | 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).
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 |
| doi_str_mv | 10.1212/WNL.0000000000207129 |
| format | Article |
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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.
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,
= 0.004) and survival (50% vs 14%
= 0.005).
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.</description><identifier>ISSN: 0028-3878</identifier><identifier>ISSN: 1526-632X</identifier><identifier>EISSN: 1526-632X</identifier><identifier>DOI: 10.1212/WNL.0000000000207129</identifier><identifier>PMID: 36889924</identifier><language>eng</language><publisher>United States: Lippincott Williams & Wilkins</publisher><subject>Adult ; Anticonvulsants - therapeutic use ; Cohort Studies ; Electroencephalography ; Humans ; Hypoxia, Brain ; Retrospective Studies ; Seizures - drug therapy ; Status Epilepticus</subject><ispartof>Neurology, 2023-05, Vol.100 (19), p.e1955-e1966</ispartof><rights>Lippincott Williams & Wilkins</rights><rights>2023 American Academy of Neurology.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3014-33bd9dabadc2241c846b856dde1fb6d55869f4ed1376d910f2fa06c2477bdf073</cites><orcidid>0000-0002-4095-2765 ; 0000-0002-0342-9780 ; 0000-0003-3648-3609 ; 0000-0003-1557-9062 ; 0000-0002-6575-356X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36889924$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fisch, Urs</creatorcontrib><creatorcontrib>Jünger, Anja L.</creatorcontrib><creatorcontrib>Baumann, Sira M.</creatorcontrib><creatorcontrib>Semmlack, Saskia</creatorcontrib><creatorcontrib>De Marchis, Gian Marco</creatorcontrib><creatorcontrib>Hunziker, Sabina</creatorcontrib><creatorcontrib>Rüegg, Stephan</creatorcontrib><creatorcontrib>Marsch, Stephan</creatorcontrib><creatorcontrib>Sutter, Raoul</creatorcontrib><title>Association Between Induced Burst Suppression and Clinical Outcomes in Patients With Refractory Status Epilepticus: A 9-Year Cohort Study</title><title>Neurology</title><addtitle>Neurology</addtitle><description>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).
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.
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,
= 0.004) and survival (50% vs 14%
= 0.005).
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.</description><subject>Adult</subject><subject>Anticonvulsants - therapeutic use</subject><subject>Cohort Studies</subject><subject>Electroencephalography</subject><subject>Humans</subject><subject>Hypoxia, Brain</subject><subject>Retrospective Studies</subject><subject>Seizures - drug therapy</subject><subject>Status Epilepticus</subject><issn>0028-3878</issn><issn>1526-632X</issn><issn>1526-632X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdUdtu1DAQtRCILoU_QMiPvKT4FsfmbbsqUGnVIgoqPEWOPdEasnHqi1b7Cfx1s_QmMS8jzZyLZg5Cbyk5oYyyD9cX6xPyWIw0lOlnaEFrJivJ2c_naDGPVcVVo47Qq5R-EzIvG_0SHXGplNZMLNDfZUrBepN9GPEp5B3AiM9HVyw4fFpiyviqTFOElA4IMzq8GvzorRnwZck2bCFhP-KvswKMOeFrnzf4G_TR2BziHl9lk0vCZ5MfYMrelvQRL7GufoGJeBU2Ic4Oubj9a_SiN0OCN_f9GP34dPZ99aVaX34-Xy3XleWEiorzzmlnOuMsY4JaJWSnaukc0L6Trq6V1L0AR3kjnaakZ70h0jLRNJ3rScOP0fs73SmGmwIpt1ufLAyDGSGU1LJG1YwQIQ9QcQe1MaQUoW-n6Lcm7ltK2kMI7RxC-38IM-3dvUPptuAeSQ9ff9LdhSFDTH-GsoPYbsAMefNPT9L5VEYYJzXRpDqMBL8Fb3yTxA</recordid><startdate>20230509</startdate><enddate>20230509</enddate><creator>Fisch, Urs</creator><creator>Jünger, Anja L.</creator><creator>Baumann, Sira M.</creator><creator>Semmlack, Saskia</creator><creator>De Marchis, Gian Marco</creator><creator>Hunziker, Sabina</creator><creator>Rüegg, Stephan</creator><creator>Marsch, Stephan</creator><creator>Sutter, Raoul</creator><general>Lippincott Williams & Wilkins</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-4095-2765</orcidid><orcidid>https://orcid.org/0000-0002-0342-9780</orcidid><orcidid>https://orcid.org/0000-0003-3648-3609</orcidid><orcidid>https://orcid.org/0000-0003-1557-9062</orcidid><orcidid>https://orcid.org/0000-0002-6575-356X</orcidid></search><sort><creationdate>20230509</creationdate><title>Association Between Induced Burst Suppression and Clinical Outcomes in Patients With Refractory Status Epilepticus: A 9-Year Cohort Study</title><author>Fisch, Urs ; Jünger, Anja L. ; Baumann, Sira M. ; Semmlack, Saskia ; De Marchis, Gian Marco ; Hunziker, Sabina ; Rüegg, Stephan ; Marsch, Stephan ; Sutter, Raoul</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3014-33bd9dabadc2241c846b856dde1fb6d55869f4ed1376d910f2fa06c2477bdf073</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adult</topic><topic>Anticonvulsants - therapeutic use</topic><topic>Cohort Studies</topic><topic>Electroencephalography</topic><topic>Humans</topic><topic>Hypoxia, Brain</topic><topic>Retrospective Studies</topic><topic>Seizures - drug therapy</topic><topic>Status Epilepticus</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fisch, Urs</creatorcontrib><creatorcontrib>Jünger, Anja L.</creatorcontrib><creatorcontrib>Baumann, Sira M.</creatorcontrib><creatorcontrib>Semmlack, Saskia</creatorcontrib><creatorcontrib>De Marchis, Gian Marco</creatorcontrib><creatorcontrib>Hunziker, Sabina</creatorcontrib><creatorcontrib>Rüegg, Stephan</creatorcontrib><creatorcontrib>Marsch, Stephan</creatorcontrib><creatorcontrib>Sutter, Raoul</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fisch, Urs</au><au>Jünger, Anja L.</au><au>Baumann, Sira M.</au><au>Semmlack, Saskia</au><au>De Marchis, Gian Marco</au><au>Hunziker, Sabina</au><au>Rüegg, Stephan</au><au>Marsch, Stephan</au><au>Sutter, Raoul</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association Between Induced Burst Suppression and Clinical Outcomes in Patients With Refractory Status Epilepticus: A 9-Year Cohort Study</atitle><jtitle>Neurology</jtitle><addtitle>Neurology</addtitle><date>2023-05-09</date><risdate>2023</risdate><volume>100</volume><issue>19</issue><spage>e1955</spage><epage>e1966</epage><pages>e1955-e1966</pages><issn>0028-3878</issn><issn>1526-632X</issn><eissn>1526-632X</eissn><abstract>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).
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.
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,
= 0.004) and survival (50% vs 14%
= 0.005).
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.</abstract><cop>United States</cop><pub>Lippincott Williams & Wilkins</pub><pmid>36889924</pmid><doi>10.1212/WNL.0000000000207129</doi><orcidid>https://orcid.org/0000-0002-4095-2765</orcidid><orcidid>https://orcid.org/0000-0002-0342-9780</orcidid><orcidid>https://orcid.org/0000-0003-3648-3609</orcidid><orcidid>https://orcid.org/0000-0003-1557-9062</orcidid><orcidid>https://orcid.org/0000-0002-6575-356X</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Anticonvulsants - therapeutic use Cohort Studies Electroencephalography Humans Hypoxia, Brain Retrospective Studies Seizures - drug therapy Status Epilepticus |
| title | Association Between Induced Burst Suppression and Clinical Outcomes in Patients With Refractory Status Epilepticus: A 9-Year Cohort Study |
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