Spectral properties of bursts in therapeutic burst suppression predict successful treatment of refractory status epilepticus
[Display omitted] •In therapeutic burst suppression, high amounts of fast frequencies in bursts predict status recurrence.•In cases of status recurrence, spectral composition of bursts and preceding ictal patterns bear a high resemblance.•EEG guided individualized sedation regimes should be given pr...
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| Veröffentlicht in: | Epilepsy & behavior 2024-12, Vol.161, p.110093, Article 110093 |
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| creator | Gollwitzer, Stephanie Hopfengärtner, Rüdiger Rampp, Stefan Welte, Tamara Madžar, Dominik Lang, Johannes Reindl, Caroline Stritzelberger, Jenny Koehn, Julia Kuramatsu, Joji Schwab, Stefan Huttner, Hagen B. Hamer, Hajo |
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•In therapeutic burst suppression, high amounts of fast frequencies in bursts predict status recurrence.•In cases of status recurrence, spectral composition of bursts and preceding ictal patterns bear a high resemblance.•EEG guided individualized sedation regimes should be given preference over fixed anesthesia protocols.
Burst suppression (BS) on EEG induced by intravenous anesthesia (IVAT) is standard therapy for refractory status epilepticus (RSE). If BS has any independent therapeutic effect on RSE is disputed. We aimed to define EEG characteristics of BS predicting termination or recurrence of status after weaning. All RSE patients treated with IVAT while undergoing continuous EEG monitoring on the neurological intensive care unit between 2014 and 2019 were screened for inclusion. A one hour-period of visually preselected BS-EEG was analyzed. Bursts were segmented by a special thresholding technique and underwent power spectral analysis. Out of 48 enrolled patients, 25 (52.1 %) did not develop seizure recurrence (group Non SE) after weaning from IVAT; in 23 patients (47.9 %), SE reestablished (group SE). In group Non SE, bursts contained higher amounts of EEG delta power (91.59 % vs 80.53 %, p |
| doi_str_mv | 10.1016/j.yebeh.2024.110093 |
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•In therapeutic burst suppression, high amounts of fast frequencies in bursts predict status recurrence.•In cases of status recurrence, spectral composition of bursts and preceding ictal patterns bear a high resemblance.•EEG guided individualized sedation regimes should be given preference over fixed anesthesia protocols.
Burst suppression (BS) on EEG induced by intravenous anesthesia (IVAT) is standard therapy for refractory status epilepticus (RSE). If BS has any independent therapeutic effect on RSE is disputed. We aimed to define EEG characteristics of BS predicting termination or recurrence of status after weaning. All RSE patients treated with IVAT while undergoing continuous EEG monitoring on the neurological intensive care unit between 2014 and 2019 were screened for inclusion. A one hour-period of visually preselected BS-EEG was analyzed. Bursts were segmented by a special thresholding technique and underwent power spectral analysis. Out of 48 enrolled patients, 25 (52.1 %) did not develop seizure recurrence (group Non SE) after weaning from IVAT; in 23 patients (47.9 %), SE reestablished (group SE). In group Non SE, bursts contained higher amounts of EEG delta power (91.59 % vs 80.53 %, p < 0.0001), while faster frequencies were more pronounced in bursts in group SE (theta: 11.38 % vs 5.41 %, p = 0.0008; alpha: 4.89 % vs 1.82 %, p < 0.0001; beta: 3.23 % vs 1.21 %, p = 0.0002). Spectral profiles of individual bursts closely resembled preceding seizure patterns in group SE but not in group Non SE. Accordingly, persistence of spectral composition of initial ictal patterns in bursts, suggests ongoing SE, merely interrupted but not altered by BS. Fast oscillations in bursts indicate a high risk of status recurrence after weaning from IVAT. EEG guided individualized sedation regimes might therefore be superior to standardized anesthesia protocols.</description><identifier>ISSN: 1525-5050</identifier><identifier>ISSN: 1525-5069</identifier><identifier>EISSN: 1525-5069</identifier><identifier>DOI: 10.1016/j.yebeh.2024.110093</identifier><identifier>PMID: 39489997</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Anesthesia, Intravenous - methods ; Brain Waves - drug effects ; Brain Waves - physiology ; Drug Resistant Epilepsy - drug therapy ; Drug Resistant Epilepsy - physiopathology ; Electroencephalography - methods ; Female ; Humans ; Intravenous anesthesia ; Male ; Middle Aged ; Multimodal monitoring ; Quantitative EEG ; Status Epilepticus - drug therapy ; Status Epilepticus - physiopathology ; Treatment Outcome</subject><ispartof>Epilepsy & behavior, 2024-12, Vol.161, p.110093, Article 110093</ispartof><rights>2024 The Author(s)</rights><rights>Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c284t-9c8628acfd8bb3396bb5c8447f5c22c54484570566c73407d217468d3b703fdb3</cites><orcidid>0000-0002-6430-7947 ; 0000-0002-4888-6539 ; 0000-0003-1709-8617</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.yebeh.2024.110093$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39489997$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gollwitzer, Stephanie</creatorcontrib><creatorcontrib>Hopfengärtner, Rüdiger</creatorcontrib><creatorcontrib>Rampp, Stefan</creatorcontrib><creatorcontrib>Welte, Tamara</creatorcontrib><creatorcontrib>Madžar, Dominik</creatorcontrib><creatorcontrib>Lang, Johannes</creatorcontrib><creatorcontrib>Reindl, Caroline</creatorcontrib><creatorcontrib>Stritzelberger, Jenny</creatorcontrib><creatorcontrib>Koehn, Julia</creatorcontrib><creatorcontrib>Kuramatsu, Joji</creatorcontrib><creatorcontrib>Schwab, Stefan</creatorcontrib><creatorcontrib>Huttner, Hagen B.</creatorcontrib><creatorcontrib>Hamer, Hajo</creatorcontrib><title>Spectral properties of bursts in therapeutic burst suppression predict successful treatment of refractory status epilepticus</title><title>Epilepsy & behavior</title><addtitle>Epilepsy Behav</addtitle><description>[Display omitted]
•In therapeutic burst suppression, high amounts of fast frequencies in bursts predict status recurrence.•In cases of status recurrence, spectral composition of bursts and preceding ictal patterns bear a high resemblance.•EEG guided individualized sedation regimes should be given preference over fixed anesthesia protocols.
Burst suppression (BS) on EEG induced by intravenous anesthesia (IVAT) is standard therapy for refractory status epilepticus (RSE). If BS has any independent therapeutic effect on RSE is disputed. We aimed to define EEG characteristics of BS predicting termination or recurrence of status after weaning. All RSE patients treated with IVAT while undergoing continuous EEG monitoring on the neurological intensive care unit between 2014 and 2019 were screened for inclusion. A one hour-period of visually preselected BS-EEG was analyzed. Bursts were segmented by a special thresholding technique and underwent power spectral analysis. Out of 48 enrolled patients, 25 (52.1 %) did not develop seizure recurrence (group Non SE) after weaning from IVAT; in 23 patients (47.9 %), SE reestablished (group SE). In group Non SE, bursts contained higher amounts of EEG delta power (91.59 % vs 80.53 %, p < 0.0001), while faster frequencies were more pronounced in bursts in group SE (theta: 11.38 % vs 5.41 %, p = 0.0008; alpha: 4.89 % vs 1.82 %, p < 0.0001; beta: 3.23 % vs 1.21 %, p = 0.0002). Spectral profiles of individual bursts closely resembled preceding seizure patterns in group SE but not in group Non SE. Accordingly, persistence of spectral composition of initial ictal patterns in bursts, suggests ongoing SE, merely interrupted but not altered by BS. Fast oscillations in bursts indicate a high risk of status recurrence after weaning from IVAT. EEG guided individualized sedation regimes might therefore be superior to standardized anesthesia protocols.</description><subject>Adult</subject><subject>Aged</subject><subject>Anesthesia, Intravenous - methods</subject><subject>Brain Waves - drug effects</subject><subject>Brain Waves - physiology</subject><subject>Drug Resistant Epilepsy - drug therapy</subject><subject>Drug Resistant Epilepsy - physiopathology</subject><subject>Electroencephalography - methods</subject><subject>Female</subject><subject>Humans</subject><subject>Intravenous anesthesia</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multimodal monitoring</subject><subject>Quantitative EEG</subject><subject>Status Epilepticus - drug therapy</subject><subject>Status Epilepticus - physiopathology</subject><subject>Treatment Outcome</subject><issn>1525-5050</issn><issn>1525-5069</issn><issn>1525-5069</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kEuLFDEUhQtRnIf-AkGydNNtnlXJwoUMow4MuFDXIUndYtJUV8XcRGjwx5u2xlm6Sjicc-69X9e9YXTPKOvfH_Yn8PCw55TLPWOUGvGsu2SKq52ivXn-9Ff0ortCPFDKmBLsZXchjNTGmOGy-_0tQSjZzSTlNUEuEZCsE_E1Y0ESF1IeILsEtcSwqQRrShkQ47q0FIwxnLUQmjTVmZQMrhxhKeeeDFN2oaz5RLC4UpFAijOk1lbxVfdicjPC68f3uvvx6fb7zZfd_dfPdzcf73eBa1l2JuieaxemUXsvhOm9V0FLOUwqcB6UlFqqgaq-D4OQdBg5G2SvR-EHKqbRi-vu3dbbbvxZAYs9Rgwwz26BtaIVjAtNBdWmWcVmDXlFbNvblOPR5ZNl1J6x24P9i92esdsNe0u9fRxQ_RHGp8w_zs3wYTNAO_NXhGwxRFhCg5cbfzuu8b8D_gBblpe7</recordid><startdate>202412</startdate><enddate>202412</enddate><creator>Gollwitzer, Stephanie</creator><creator>Hopfengärtner, Rüdiger</creator><creator>Rampp, Stefan</creator><creator>Welte, Tamara</creator><creator>Madžar, Dominik</creator><creator>Lang, Johannes</creator><creator>Reindl, Caroline</creator><creator>Stritzelberger, Jenny</creator><creator>Koehn, Julia</creator><creator>Kuramatsu, Joji</creator><creator>Schwab, Stefan</creator><creator>Huttner, Hagen B.</creator><creator>Hamer, Hajo</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</scope><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/0000-0002-6430-7947</orcidid><orcidid>https://orcid.org/0000-0002-4888-6539</orcidid><orcidid>https://orcid.org/0000-0003-1709-8617</orcidid></search><sort><creationdate>202412</creationdate><title>Spectral properties of bursts in therapeutic burst suppression predict successful treatment of refractory status epilepticus</title><author>Gollwitzer, Stephanie ; Hopfengärtner, Rüdiger ; Rampp, Stefan ; Welte, Tamara ; Madžar, Dominik ; Lang, Johannes ; Reindl, Caroline ; Stritzelberger, Jenny ; Koehn, Julia ; Kuramatsu, Joji ; Schwab, Stefan ; Huttner, Hagen B. ; Hamer, Hajo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c284t-9c8628acfd8bb3396bb5c8447f5c22c54484570566c73407d217468d3b703fdb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Anesthesia, Intravenous - methods</topic><topic>Brain Waves - drug effects</topic><topic>Brain Waves - physiology</topic><topic>Drug Resistant Epilepsy - drug therapy</topic><topic>Drug Resistant Epilepsy - physiopathology</topic><topic>Electroencephalography - methods</topic><topic>Female</topic><topic>Humans</topic><topic>Intravenous anesthesia</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multimodal monitoring</topic><topic>Quantitative EEG</topic><topic>Status Epilepticus - drug therapy</topic><topic>Status Epilepticus - physiopathology</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gollwitzer, Stephanie</creatorcontrib><creatorcontrib>Hopfengärtner, Rüdiger</creatorcontrib><creatorcontrib>Rampp, Stefan</creatorcontrib><creatorcontrib>Welte, Tamara</creatorcontrib><creatorcontrib>Madžar, Dominik</creatorcontrib><creatorcontrib>Lang, Johannes</creatorcontrib><creatorcontrib>Reindl, Caroline</creatorcontrib><creatorcontrib>Stritzelberger, Jenny</creatorcontrib><creatorcontrib>Koehn, Julia</creatorcontrib><creatorcontrib>Kuramatsu, Joji</creatorcontrib><creatorcontrib>Schwab, Stefan</creatorcontrib><creatorcontrib>Huttner, Hagen B.</creatorcontrib><creatorcontrib>Hamer, Hajo</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><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>Epilepsy & behavior</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gollwitzer, Stephanie</au><au>Hopfengärtner, Rüdiger</au><au>Rampp, Stefan</au><au>Welte, Tamara</au><au>Madžar, Dominik</au><au>Lang, Johannes</au><au>Reindl, Caroline</au><au>Stritzelberger, Jenny</au><au>Koehn, Julia</au><au>Kuramatsu, Joji</au><au>Schwab, Stefan</au><au>Huttner, Hagen B.</au><au>Hamer, Hajo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Spectral properties of bursts in therapeutic burst suppression predict successful treatment of refractory status epilepticus</atitle><jtitle>Epilepsy & behavior</jtitle><addtitle>Epilepsy Behav</addtitle><date>2024-12</date><risdate>2024</risdate><volume>161</volume><spage>110093</spage><pages>110093-</pages><artnum>110093</artnum><issn>1525-5050</issn><issn>1525-5069</issn><eissn>1525-5069</eissn><abstract>[Display omitted]
•In therapeutic burst suppression, high amounts of fast frequencies in bursts predict status recurrence.•In cases of status recurrence, spectral composition of bursts and preceding ictal patterns bear a high resemblance.•EEG guided individualized sedation regimes should be given preference over fixed anesthesia protocols.
Burst suppression (BS) on EEG induced by intravenous anesthesia (IVAT) is standard therapy for refractory status epilepticus (RSE). If BS has any independent therapeutic effect on RSE is disputed. We aimed to define EEG characteristics of BS predicting termination or recurrence of status after weaning. All RSE patients treated with IVAT while undergoing continuous EEG monitoring on the neurological intensive care unit between 2014 and 2019 were screened for inclusion. A one hour-period of visually preselected BS-EEG was analyzed. Bursts were segmented by a special thresholding technique and underwent power spectral analysis. Out of 48 enrolled patients, 25 (52.1 %) did not develop seizure recurrence (group Non SE) after weaning from IVAT; in 23 patients (47.9 %), SE reestablished (group SE). In group Non SE, bursts contained higher amounts of EEG delta power (91.59 % vs 80.53 %, p < 0.0001), while faster frequencies were more pronounced in bursts in group SE (theta: 11.38 % vs 5.41 %, p = 0.0008; alpha: 4.89 % vs 1.82 %, p < 0.0001; beta: 3.23 % vs 1.21 %, p = 0.0002). Spectral profiles of individual bursts closely resembled preceding seizure patterns in group SE but not in group Non SE. Accordingly, persistence of spectral composition of initial ictal patterns in bursts, suggests ongoing SE, merely interrupted but not altered by BS. Fast oscillations in bursts indicate a high risk of status recurrence after weaning from IVAT. EEG guided individualized sedation regimes might therefore be superior to standardized anesthesia protocols.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>39489997</pmid><doi>10.1016/j.yebeh.2024.110093</doi><orcidid>https://orcid.org/0000-0002-6430-7947</orcidid><orcidid>https://orcid.org/0000-0002-4888-6539</orcidid><orcidid>https://orcid.org/0000-0003-1709-8617</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Anesthesia, Intravenous - methods Brain Waves - drug effects Brain Waves - physiology Drug Resistant Epilepsy - drug therapy Drug Resistant Epilepsy - physiopathology Electroencephalography - methods Female Humans Intravenous anesthesia Male Middle Aged Multimodal monitoring Quantitative EEG Status Epilepticus - drug therapy Status Epilepticus - physiopathology Treatment Outcome |
| title | Spectral properties of bursts in therapeutic burst suppression predict successful treatment of refractory status epilepticus |
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