EEG Characteristics of Successful Burst Suppression for Refractory Status Epilepticus

Johnson, Emily L.; Martinez, Nirma Carballido; Ritzl, Eva K.

doi:10.1007/s12028-016-0294-2

Cited by 45 publications

(43 citation statements)

References 23 publications

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“…52 In the case presented, focal electrographic seizures ceased completely during DIBS but PLEDs persisted despite uptitration of anesthetic dosage (propofol up to 60 µg/kg/m, ketamine up to 65 µg/kg/m, and midazolam up to 1.2 µg/kg/m) to maintain a DIBS interburst interval of 6-12 s (burst rate of 5-10/m). The surviving PLEDs remnants were mixed with burst components, occasionally spilling over the interburst intervals (Figure 2B-D).…”

Section: Discussionmentioning

confidence: 75%

Periodic lateralized epileptiform discharges can survive anesthesia and result in asymmetric drug-induced burst suppression

et al. 2017

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Drug-induced burst suppression (DIBS) is bihemispheric and bisymmetric in adults and older children. However, asymmetric DIBS may occur if a pathological process is affecting one hemisphere only or both hemispheres disproportionately. The usual suspect is a destructive lesion; an irritative or epileptogenic lesion is usually not invoked to explain DIBS asymmetry. We report the case of a 66-year-old woman with new-onset seizures who was found to have a hemorrhagic cavernoma and periodic lateralized epileptiform discharges (PLEDs) in the right temporal region. After levetiracetam and before anesthetic antiepileptic drugs (AEDs) were administered, the electroencephalogram (EEG) showed continuous PLEDs over the right hemisphere with maximum voltage in the posterior temporal region. Focal electrographic seizures also occurred occasionally in the same location. Propofol resulted in bihemispheric, but not in bisymmetric, DIBS. Remnants or fragments of PLEDs that survived anesthesia increased the amplitude and complexity of the bursts in the right hemisphere leading to asymmetric DIBS. Phenytoin, lacosamide, ketamine, midazolam, and topiramate were administered at various times in the course of EEG monitoring, resulting in suppression of seizures but not of PLEDs. Ketamine and midazolam reduced the rate, amplitude, and complexity of PLEDs but only after producing substantial attenuation of all burst components. When all anesthetics were discontinued, the EEG reverted to the original preanesthesia pattern with continuous non-fragmented PLEDs. The fact that PLEDs can survive anesthesia and affect DIBS symmetry is a testament to the robustness of the neurodynamic processes underlying PLEDs.

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Section: Discussionmentioning

confidence: 75%

Periodic lateralized epileptiform discharges can survive anesthesia and result in asymmetric drug-induced burst suppression

et al. 2017

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“…In the same systematic review as above, compared with seizure suppression (30% of patients), titration of treatment to EEG background suppression (45% of patients) was associated with a significantly lower frequency of breakthrough seizures (4 versus 53%) and a higher frequency of hypotension (76 versus 29%). When aiming for burst suppression, the characteristic of the bursts is a better predictor of success in termination of RSE [ 95 , 96 ]. While one theory suggests that burst suppression allows for the brain to rest, recover, and suppress the epileptiform activity, the disadvantage might be a worse outcome overall due to the need to use anesthetics and resulting prolonged intubation and hospitalization [ 11 ].…”

Section: Treatmentmentioning

confidence: 99%

Updates in Refractory Status Epilepticus

Marawar

Basha

Mahulikar

et al. 2018

Critical Care Research and Practice

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Refractory status epilepticus is defined as persistent seizures despite appropriate use of two intravenous medications, one of which is a benzodiazepine. It can be seen in up to 40% of cases of status epilepticus with an acute symptomatic etiology as the most likely cause. New-onset refractory status epilepticus (NORSE) is a recently coined term for refractory status epilepticus where no apparent cause is found after initial testing. A large proportion of NORSE cases are eventually found to have an autoimmune etiology needing immunomodulatory treatment. Management of refractory status epilepticus involves treatment of an underlying etiology in addition to intravenous anesthetics and antiepileptic drugs. Alternative treatment options including diet therapies, electroconvulsive therapy, and surgical resection in case of a focal lesion should be considered. Short-term and long-term outcomes tend to be poor with significant morbidity and mortality with only one-third of patients reaching baseline neurological status.

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“…1 New data also suggest that "the amount of epileptic activity in the burst" is also predictive of the success of the weaning of anesthetics. 56 However, ketamine may not fit these typical EEG patterns. Diffuse slowing and diffuse beta activity patterns can also be targeted to achieve along with the burst-suppression.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic Use In Status Epilepticus: A Concise Review

Yilmaz

Igneri

Yilmaz

et al. 2020

CRMJ

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The purpose of this review is to summarize the recent literature focusing on intravenous (IV) administration of commonly used anesthetics, including midazolam, pentobarbital/ thiopental, propofol, and ketamine in the treatment of status epilepticus (SE). Anesthetics should be reserved as third-line therapy for the treatment of SE when benzodiazepines and other second-line agents fail to terminate the seizure. We have reviewed the literature related to the treatment of status epilepticus, refractory status epilepticus, super-refractory status epilepticus, anesthetics, midazolam, pentobarbital/thiopental, propofol, and ketamine. This paper focuses on the pharmacology, dosages, major side effects, and clinical use of IV anesthetics in the treatment of SE with an emphasis on the developing literature supporting the use of ketamine for this indication. Based on the available literature, we propose recommendations for third-line agent selection in the management of SE.

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EEG Characteristics of Successful Burst Suppression for Refractory Status Epilepticus

Abstract: The length of interburst intervals and burst suppression did not predict successful termination of RSE in this small cohort. This may suggest that EEG characteristics, rather a strict interburst interval goal, could guide IVAT for RSE.

Cited by 45 publications

References 23 publications

Periodic lateralized epileptiform discharges can survive anesthesia and result in asymmetric drug-induced burst suppression

Periodic lateralized epileptiform discharges can survive anesthesia and result in asymmetric drug-induced burst suppression

Updates in Refractory Status Epilepticus

Anesthetic Use In Status Epilepticus: A Concise Review

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