Emergency EEG: study of survival

Abstract

Objective: To determine the survival rate according to the main findings of emergency electroencephalography (EEGs) of patients treated in a tertiary hospital. Method: In this prospective study, the findings of consecutive emergency EEGs performed on inpatients in Hospital de Base in São José do Rio Preto, Brazil were correlated with survival utilizing KaplanMeyer survival curves. results: A total of 681 patients with an average age of 42 years old (1 day to 96 years) were evaluated, of which 406 were male. The main reasons for EEGs were epileptic seizures (221 cases), hepatic encephalopathy [116 cases of which 85 (73.3%) were men, p-value=0.001], status epilepticus (104 cases) and impaired consciousness (78 cases). The underlying disease was confirmed in 578 (84.3%) cases with 119 (17.5%) having liver disease [91 (76.0%) were men, p-value=0.001], 105 (15.4%) suffering strokes, 67 (9.9%) having metabolic disorders, 51 (7.5%) central nervous system infections and 49 (7.2%) epilepsy. In the three months following EEG, a survival rate of 75% was found in patients with normal, discreet slow activity or intermittent rhythmic delta activity EEGs, of 50% for those with continuous delta activity and generalized epileptiform discharges, and of 25% for those with burst-suppression, diffuse depression, and in alpha/theta-pattern coma. Death was pronounced immediately in patients with isoelectric EEGs. conclusion: The main findings of EEGs, differentiated different survival rates and are thus a good prognostic tool for patients examined in emergencies. Key words: EEG, emergency, prognosis, probability of survival.EEG de urgência: taxa de sobrevivência rEsuMO Objetivo: Determinar a taxa de sobrevivência (TS), segundo os principais achados de eletrencefalograma de urgência (E-EEG), dos pacientes atendidos nas emergências de hospital de alta complexidade. Método: Estudo prospectivo, por ordem de chegada, da correlação entre os achados de E-EEG, feitos nos pacientes à beira do leito, com TS, utilizando-se as curvas de sobrevidas de Kaplan Meyer no Hospital de Base de São José do Rio Preto, São Paulo/Brasil. resultados: Foram estudados 681 pacientes, dos quais 406 (59,6%) masculinos, com idade média de 42 anos (1 dia a 96 anos). As principais motivações para o E-EEG foram crises epilépticas (221 casos), encefalopatia hepática [(116 casos, dos quais 85 masculinos (73,3%), p= 0,001]; estado de mal epiléptico 104 e rebaixamento de consciência 78. O diagnóstico da doença de base foi confirmado em 578 (84,3%), sendo 119 (17,5%) hepatopatia, dos quais 91 (76,%) masculinos, p= 0,001; 105 (15,4%) acidente vascular encefálico; 67 (9,9%) distúrbio metabólico; 51 (7,5%) infecção do sistema nervoso central e 49 (7,2%) epilepsia. TS de 75% nos três primeiros meses foi encontrada nos pacientes com

The new wave: time to bring EEG to the emergency department

“…The utility of acute EEG recordings was 100% in subjects with a referral diagnosis of SE [3]. In addition to the present evidence on the usefulness of acute EEG availability in early seizure detection and patient management, EEG findings could serve as a prognostic tool for subjects presenting with neurological and non-neurological emergencies [41-43]. It is worth noting that a single EEG with complete generalized suppression in comatose survivors after cardiac arrest indicates no possibility of recovery in the level of consciousness [44].…”

Pathophysiology and the Monitoring Methods for Cardiac Arrest Associated Brain Injury

“…Thus, most EEG records have been done in CA with therapeutic hypothermia in humans. Recent studies showed that bispectral index (<40, a calculated summary of raw EEG data including frequency and amplitude) [ 53 , 54 ], burst suppression (a quantitative EGG parameter) [ 55 , 56 ], periodic discharges (commonly recognized patterns of abnormal EEG) [ 57 , 58 ], epileptiform discharges (an uncommon EEG pattern including periodic spike, sharp and slow wave complex and more common in people with epilepsy) [ 59 ], stimulus-induced rhythmic periodic, or ictal discharges (a spectrum of stimulation-induced EEG pattern) [ 60 ] in the EEG records after successful resuscitation with non-therapeutic hypothermia may indicate poor prognosis. In addition, a non-reactive EEG [ 61 , 62 ] may predict poor prognosis in patients without therapeutic hypothermia, while rhythmic delta activity may indicate better prognosis [ 55 , 58 ] after CA [ 63 ].…”

Dilated and Unreactive Pupils and Burst-Suppression on Electroencephalography due to Buproprion Overdose

“…1 The burst-suppression pattern has been observed in cases of head trauma, stroke, respiratory arrest from significant doses of narcotics or barbiturates, in patients having cardiogenic shock from massive myocardial infarction and subsequent anoxia, severe hypothermia, and in premature infants or infants with neonatal epileptic syndrome. Burst suppression is a malignant electroencephalography (EEG) finding and is indicative of a poor neurologic outcome and high mortality, 2 unless the pattern is pharmacologically induced for treatment purposes in a controlled environment via sedative agents such as propofol, barbiturates, or benzodiazepines. 3,4 Our case is presumably the second documented case of a bupropion overdose causing a burst-suppression pattern on EEG.…”