Significance of Reactive Burst Suppression following Asphyxia in Full Term Infants

Holmes, Gregory L.; Rowe, Jonelle; Hafford, James

doi:10.1177/155005948301400308

Cited by 30 publications

(12 citation statements)

References 2 publications

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“…Ischemic brain injury affects synaptic transmission, axonal conduction, and cellular action potential firing in a sequential manner and plays a critical role in determining characteristics of EEG [20]. Since the EEG provides an insight into the thalamocortical function and has been used for prognostication after resuscitation from CA during normothermia, the development of accurate monitoring techniques employing EEG to evaluate the effectiveness of hypothermia and early prediction of neurological outcome may be anticipated [24].…”

Section: Resultsmentioning

confidence: 99%

“…Previous studies found that EEG burst characteristics were associated with neurological recovery in animal model of CA from asphyxia [18, 19]. At the same time, observational clinical studies reported that persistence of isoelectric activity, burst suppression, or generalized epileptiform discharges on EEG was associated with poor outcomes [20–23]. Although unprocessed EEG interpretation observed during the early stage after resuscitation has been used to assist the prediction of a poor outcome in comatose survivors without hypothermia with some success, the prognostic accuracy was insufficient, especially in the era of hypothermia [24–27].…”

Section: Introductionmentioning

confidence: 99%

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Improved Early Postresuscitation EEG Activity for Animals Treated with Hypothermia Predicted 96 hr Neurological Outcome and Survival in a Rat Model of Cardiac Arrest

Chen

Song

Sun

et al. 2013

BioMed Research International

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Purpose. To investigate the effect of hypothermia on 96 hr neurological outcome and survival by quantitatively characterizing early postresuscitation EEG in a rat model of cardiac arrest. Materials and Methods. In twenty male Sprague-Dawley rats, cardiac arrest was induced through high frequency transesophageal cardiac pacing. Cardiopulmonary resuscitation was initiated after 5 mins untreated arrest. Immediately after resuscitation, animals were randomized to either 2 hrs of hypothermia (N = 10) or normothermia (N = 10). EEG, ECG, aortic pressure, and core temperature were continuously recorded for 6 hrs. Neurological outcome was evaluated daily during the 96 hrs postresuscitation period. Results. No differences in the baseline measurements and resuscitation outcome were observed between groups. However, 96 hr neurological deficit score (204 ± 255 versus 500 ± 0, P = 0.005) and survival (6/10 versus 0/10, P = 0.011) were significantly better in the hypothermic group. Quantitative analysis of early postresuscitation EEG revealed that burst frequency and spectrum entropy were greatly improved in the hypothermic group and correlated with 96 hr neurological outcome and survival. Conclusion. The improved burst frequency during burst suppression period and preserved spectrum entropy after restoration of continuous background EEG activity for animals treated with hypothermia predicted favorable neurological outcome and survival in this rat model of cardiac arrest.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Improved Early Postresuscitation EEG Activity for Animals Treated with Hypothermia Predicted 96 hr Neurological Outcome and Survival in a Rat Model of Cardiac Arrest

Chen

Song

Sun

et al. 2013

BioMed Research International

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“…There are consistent background EEG abnormalities that are usually associated to unfavorable outcome as low voltage and burst -suppression pattern (BS) [15][16][17][18][19][20][21] . BS, an abnormal EEG pattern, included among the broad spectrum of discontinuity in neonatal EEG, is termed reactive when it can be interrupted by stimulation 22,23 and non reactive in the contrary, this last pattern has been traditionally associated with unfavorable outcome 15,21,24,25 . BS pattern is also the hallmark of two specific epileptic neonatal syndromes, early myoclonic encephalopathy and early infantile epileptic encephalopathy 26,27 .…”

Section: Prognostic Value Of Non-reactive Burst Suppression Eeg Pattementioning

confidence: 99%

Prognostic value of non-reactive burst suppression EEG pattern associated to early neonatal seizures

Nunes

Giraldes

Pinho

et al. 2005

Arq. Neuro-Psiquiatr.

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-Seizures are the most frequent neurological event in newborns and clinical data suggest that etiology is the dominant factor in long term outcome. However, there are consistent background EEG abnormalities associated to neonatal seizures that are usually related to unfavorable outcome as the burst -suppression pattern. Objective: The objective of this study was to correlate clinical and EEG features associated to long -term outcome of newborns with non -reactive burst -suppression (BS) EEG. Method: Newborns included in the study were selected from our database and had conceptional age (at the time of first EEG) >37 weeks, EEG recordings with non -reactive BS available for review and clinical follow up. Results: 12 newborns met inclusion criteria, 50% had seizures in the first day of life. Seizures became refractory to treatment in all of them. In 50% the etiology of seizures was considered cryptogenic, 33% had inborn errors of metabolism and 17% had clinical history and neuroimage suggestive of hypoxic-ischemic encephalopathy. The follow-up showed that 7/12 infants deceased, 3 during the first year of life, and one in the neonatal period. All the survivors had severe developmental delay and multifocal neurological impairment. 92% developed refractory epilepsy, 58% were latter diagnosed with West syndrome. Conclusion: The non-reactive BS pattern may appear related to many neonatal neurological disorders and is associated with early and refractory neonatal seizures. It is clearly associated with elevated morbidity and mortality and to the development of post-neonatal epilepsy.KEY WORDS: neonatal EEG, neonatal seizures, burst-suppression pattern, neonatal epileptic syndromes.Valor prognóstico do EEG com padrão de surto-supressão não reativo associado a convulsões neonatais precoces RESUMO -Convulsões representam o evento neurológico mais freqüente no período neonatal e a etiologia das crises parece ser o aspecto clínico mais associado ao prognóstico a longo prazo. Entretanto, existem padrões anormais de EEG, que de forma consistente relacionam-se a prognóstico, entre eles o padrão de surto -supressão. Objetivo: Este estudo teve como objetivo correlacionar aspectos clínicos e eletroencefalográficos associados a prognóstico em longo prazo de recém -nascidos (RN) com padrão de surto -supressão não reativo no EEG. Método: Foram selecionados para este estudo RN com EEG neonatal realizado no Laboratório de Neurofisiologia Clínica do Hospital São Lucas da PUCRS e acompanhados na mesma instituição, com idade concepcional superior a 37 semanas (na data do EEG), cujos registros estivessem disponíveis para revisão. Resultados: Foram incluídos 12 RN, 50% apresentaram crises convulsivas a partir do primeiro dia de vida. Em todos as convulsões eram refratárias ao tratamento medicamentoso. Em 50% a etiologia foi considerada criptogênica, 33% apresentavam erros inatos do metabolismo e 17% tinham história clíni-ca e achados de neuroimagem sugestivos de encefalopatia hipóxico -isquêmica. O seguimento clínico demonstrou que...

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“…Ischemic neuronal injury suppresses synaptic transmission, which is measured by changes in EEG (Holmes et al, 1983). In humans, EEG is suppressed within seconds of CA (Clute and Levy, 1990, Losasso et al, 1992, Moss and Rockoff, 1980) and recovers via an initial periodic bursting pattern that precedes restitution of continuous activity (Jorgensen and Malchow-Moller, 1981a).…”

Section: Introductionmentioning

confidence: 99%

Intraventricular orexin-A improves arousal and early EEG entropy in rats after cardiac arrest

et al. 2009

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The recovery of arousal after cardiac arrest (CA) is associated with evolution from electroencephalographic (EEG) burst-suppression to continuous activity. Orexin-A elicits arousal EEG during anesthetic burst-suppression. We hypothesized that orexin-A would improve arousal and EEG entropy after CA. Eighteen Wistar rats were subjected to 7-minute asphyxial CA and resuscitation. Rats were divided into treatment (n=9) and control (n=9) groups. Twenty minutes after resuscitation, the treatment group received 0.1 mL of 1nM orexin-A intraventricularly, while controls received saline. EEG was quantified using Information Quantity (IQ), a measure of entropy validated for detection of burst-suppression and arousal patterns. IQ values range from 0–1.0. Arousal was quantified using the neurological deficit scale (NDS). The ischemic neuronal fraction of hippocampus CA1 and cortex was histologically determined. Baseline and post-resuscitation characteristics were similar between the groups. The NDS score (mean±SD) at 4 hours was higher in the orexin-A group compared to controls (57.3±5.8 vs. 40.7±5.9, p<0.02), but scores were similar at 72 hours. Burst frequency was similar in both groups but the orexin-A group demonstrated higher IQ values compared to controls beginning within 10 minutes. IQ values remained significantly higher in the orexin-A group for the first 120 minutes (p=0.008) and subsequently converged. The ischemic neuronal fraction was similar between groups in cortex (p=0.54) and hippocampus CA1 (p=0.14). In rats resuscitated from CA, orexin-A transiently increased arousal and EEG entropy without worsening ischemic neuronal injury. The role of orexin-A in recovery of arousal after CA deserves further investigation.

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Significance of Reactive Burst Suppression following Asphyxia in Full Term Infants

Cited by 30 publications

References 2 publications

Improved Early Postresuscitation EEG Activity for Animals Treated with Hypothermia Predicted 96 hr Neurological Outcome and Survival in a Rat Model of Cardiac Arrest

Improved Early Postresuscitation EEG Activity for Animals Treated with Hypothermia Predicted 96 hr Neurological Outcome and Survival in a Rat Model of Cardiac Arrest

Prognostic value of non-reactive burst suppression EEG pattern associated to early neonatal seizures

Intraventricular orexin-A improves arousal and early EEG entropy in rats after cardiac arrest

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