Postanoxic alpha, theta or alpha-theta coma: Clinical setting and neurological outcome

Fernández‐Torre, José L.; López-Delgado, Anjana; Hernández-Hernández, Miguel A.; Paramio-Paz, Alicia; Pía-Martínez, Carla; Orizaola, Pedro; Martín-García, María

doi:10.1016/j.resuscitation.2017.12.022

Cited by 11 publications

(7 citation statements)

References 34 publications

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“… GOS at 1,5 years Auditory + nociceptive and/or tactile + visual Li et al (2018) [ 65 ] CA/H 73 EEG-R predicted survival with OR = 8.75 (1.48–51.95), p = 0.017. 82.1 84.1 86.8 78.7 GOS at 6 months Fernández-Torre et al (2018) [ 57 ] CA/H 26 In patients with a diagnosis of postanoxic alpha coma, theta coma, or alpha-theta coma, there was increased association of EEG-R with survival ( p = 0.07). CPC at 5 months Fantaneanu et al (2016) [ 56 ] CA/H (TH) 60 EEG-R varies depending on the stimulus modality as well as the temperature.…”

Section: Resultsmentioning

confidence: 99%

“…Kaplan et al concluded that, although the cause of alpha coma largely predicted outcome, EEG-R predicted survival because most patients with EEG-R awoke, whereas most of those without EEG-R died [ 44 ]. Fernández-Torre et al showed that in 26 patients with a diagnosis of postanoxic alpha coma, theta coma, or alpha-theta coma, EEG-R was associated with survival ( p = 0.07) [ 57 ]. In 2009, Rossetti et al found that postanoxic status epilepticus patients with favorable outcome exhibited preserved brainstem reflexes, cortical somatosensory evoked potentials (SSEPs), and reactive EEG background [ 18 ].…”

Section: Resultsmentioning

confidence: 99%

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Value and mechanisms of EEG reactivity in the prognosis of patients with impaired consciousness: a systematic review

et al. 2018

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BackgroundElectroencephalography (EEG) is a well-established tool for assessing brain function that is available at the bedside in the intensive care unit (ICU). This review aims to discuss the relevance of electroencephalographic reactivity (EEG-R) in patients with impaired consciousness and to describe the neurophysiological mechanisms involved.MethodsWe conducted a systematic search of the term “EEG reactivity and coma” using the PubMed database. The search encompassed articles published from inception to March 2018 and produced 202 articles, of which 42 were deemed relevant, assessing the importance of EEG-R in relationship to outcomes in patients with impaired consciousness, and were therefore included in this review.ResultsAlthough definitions, characteristics and methods used to assess EEG-R are heterogeneous, several studies underline that a lack of EEG-R is associated with mortality and unfavorable outcome in patients with impaired consciousness. However, preserved EEG-R is linked to better odds of survival. Exploring EEG-R to nociceptive, auditory, and visual stimuli enables a noninvasive trimodal functional assessment of peripheral and central sensory ascending pathways that project to the brainstem, the thalamus and the cerebral cortex. A lack of EEG-R in patients with impaired consciousness may result from altered modulation of thalamocortical loop activity by afferent sensory input due to neural impairment. Assessing EEG-R is a valuable tool for the diagnosis and outcome prediction of severe brain dysfunction in critically ill patients.ConclusionsThis review emphasizes that whatever the etiology, patients with impaired consciousness featuring a reactive electroencephalogram are more likely to have a favorable outcome, whereas those with a nonreactive electroencephalogram are prone to having an unfavorable outcome. EEG-R is therefore a valuable prognostic parameter and warrants a rigorous assessment. However, current assessment methods are heterogeneous, and no consensus exists. Standardization of stimulation and interpretation methods is needed.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Value and mechanisms of EEG reactivity in the prognosis of patients with impaired consciousness: a systematic review

et al. 2018

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“…Firstly, despite the background continuity of the alpha or theta activity on EEG, specific coma patterns known as the alpha and theta comas with monotonous, invariable frontal predominance rhythms were also differentiated from the alpha and theta activities [23]. These EEG findings indicate an unfavourable prognosis [23]. Secondly, the restoration timing is another important factor.…”

Section: The Prognostic Value Of Background Eeg Frequencymentioning

confidence: 99%

“…This 60-year male patient had predominant theta waves on his EEG without an initial shockable rhythm. Many previous studies demonstrated that young CA survivors had a higher likelihood for neurological recovery, despite their presumed unfavourable prognosis, and therefore WLST should be carefully considered for CA survivors of a young age [23,26,27].…”

Section: Other Clinical Prognostic Factors Combined With Eeg Findingsmentioning

confidence: 99%

Background Frequency Patterns in Standard Electroencephalography as an Early Prognostic Tool in Out-of-Hospital Cardiac Arrest Survivors Treated with Targeted Temperature Management

Kim

Koo

et al. 2020

JCM

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We investigated the prognostic value of standard electroencephalography, a 30-min recording using 21 electrodes on the scalp, during the early post-cardiac arrest period, and evaluated the performance of electroencephalography findings combined with other clinical features for predicting favourable outcomes in comatose out-of-hospital cardiac arrest (OHCA) survivors treated with targeted temperature management (TTM). This observational registry-based study was conducted at a tertiary care hospital in Korea using the data of all consecutive adult non-traumatic comatose OHCA survivors who underwent standard electroencephalography during TTM between 2010 and 2018. The primary outcome was a 6-month favourable neurological outcome (Cerebral Performance Category score of 1 or 2). Among 170 comatose OHCA survivors with median electroencephalography time of 22 h, a 6-month favourable neurologic outcome was observed in 34.1% (58/170). After adjusting other clinical characteristics, an electroencephalography background with dominant alpha and theta waves had the highest odds ratio of 13.03 (95% confidence interval, 4.69–36.22) in multivariable logistic analysis. A combination of other clinical features (age < 65 years, initial shockable rhythm, resuscitation duration < 20 min) with an electroencephalography background with dominant alpha and theta waves increased predictive performance for favourable neurologic outcomes with a high specificity of up to 100%. A background with dominant alpha and theta waves in standard electroencephalography during TTM could be a simple and early favourable prognostic finding in comatose OHCA survivors.

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“…This elevation of theta oscillations is induced by direct damage to the brainstem, diffuse axonal damage, or other etiologies, including cerebral hypoxia [ 51 , 52 ]. Further, continuous theta rhythm had been associated with poor outcomes [ 53 ]. In our study, the decrease of the theta-band PSD was found in patients with a better outcome, which could be a marker of their preserved sensitivity to tactile stimulation.…”

Section: Discussionmentioning

confidence: 99%

Brain Oscillatory Activity during Tactile Stimulation Correlates with Cortical Thickness of Intact Areas and Predicts Outcome in Post-Traumatic Comatose Patients

et al. 2020

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In this study, we have reported a correlation between structural brain changes and electroencephalography (EEG) in response to tactile stimulation in ten comatose patients after severe traumatic brain injury (TBI). Structural morphometry showed a decrease in whole-brain cortical thickness, cortical gray matter volume, and subcortical structures in ten comatose patients compared to fifteen healthy controls. The observed decrease in gray matter volume indicated brain atrophy in coma patients induced by TBI. In resting-state EEG, the power of slow-wave activity was significantly higher (2–6 Hz), and the power of alpha and beta rhythms was lower in coma patients than in controls. During tactile stimulation, coma patients’ theta rhythm power significantly decreased compared to that in the resting state. This decrease was not observed in the control group and correlated positively with better coma outcome and the volume of whole-brain gray matter, the right putamen, and the insula. It correlated negatively with the volume of damaged brain tissue. During tactile stimulation, an increase in beta rhythm power correlated with the thickness of patients’ somatosensory cortex. Our results showed that slow-wave desynchronization, as a nonspecific response to tactile stimulation, may serve as a sensitive index of coma outcome and morphometric changes after brain injury.

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Postanoxic alpha, theta or alpha-theta coma: Clinical setting and neurological outcome

Abstract: Hypoxic-ischemic AC, TC and ATC are associated with a poor prognosis and a high rate of mortality. In younger patients with AC, TC and ATC and incomplete forms showing reactivity on the EEG, there is a greater probability of clinical recovery.

Cited by 11 publications

References 34 publications

Value and mechanisms of EEG reactivity in the prognosis of patients with impaired consciousness: a systematic review

Value and mechanisms of EEG reactivity in the prognosis of patients with impaired consciousness: a systematic review

Background Frequency Patterns in Standard Electroencephalography as an Early Prognostic Tool in Out-of-Hospital Cardiac Arrest Survivors Treated with Targeted Temperature Management

Brain Oscillatory Activity during Tactile Stimulation Correlates with Cortical Thickness of Intact Areas and Predicts Outcome in Post-Traumatic Comatose Patients

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