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Abstract Details

Intra-burst Theta During Burst-suppression Pattern in Comatose Post-cardiac Arrest Patients Correlates with Outcome; a Prospective Study
Epilepsy/Clinical Neurophysiology (EEG)
P6 - Poster Session 6 (12:00 PM-1:00 PM)

Mechanisms of neuronal recovery are not well characterized after CA. Recent studies proposed BSP as a general mechanism when low levels of adenosine triphosphate (ATP) are present leading to protection of membrane integrity in the setting of low metabolic substrate availability. In previous case series and a retrospective cohort analysis we found that theta-bursting (~4-7Hz) during BSP correlates with favorable outcomes after CA, indicating a recovery potential of the cortico-thalamic system. We aimed to validate our previous findings in an independent, prospective cohort.

To examine the association of intra-burst frequency during electroencephalographic burst-suppression pattern (BSP) with clinical outcomes in comatose post-cardiac arrest (CA) patients.

We prospectively enrolled 53 comatose post-cardiac arrest patients and assessed key clinical variables and outcomes (CPC). In patients with BSP (n=17), additional quantitative EEG analyses were performed using multi-taper methods. Burst and suppression periods were analyzed separately using previously published methods. Statistical analysis was performed using Mann-Whitney U test (continuous data) and Fisher’s exact test (categorical data).

Patients with BSP (n=17) and without BSP (n=36) did not significantly differ in most assessed clinical variables. In all 3 patients with BSP and favorable outcomes (CPC of 2), a prominent intra-burst theta (~4-7 Hz) peak was persistently present during BSP and/or the peak intra-burst frequency increased over time. In 7/14 patients with unfavorable outcomes (CPC 3-5) and BSP had featureless, flat spectra concentrating in low frequencies (<4Hz); among the remaining 5/14 patients, either only a transient intra-burst theta feature emerged or peak frequency decreased over time.

Prominent and persistent theta (~4-7Hz) peak or increasing intra-burst spectral peak frequency after anoxic brain injury may index a recovery potential. In the context of previous studies, our results emphasize the importance of optimizing metabolic substrate availability and stimulating the cortico-thalamic system during recovery from post-CA coma.

Ryka Sehgal, MD (UCSF)
Ms. Sehgal has nothing to disclose.
Kurt Y. Qing, MD (New York Presbyterian Hospital, Weill Cornell Medical Center) Dr. Qing has nothing to disclose.
Nicholas D. Schiff, MD Dr. Schiff has received publishing royalties from a publication relating to health care. Dr. Schiff has received personal compensation in the range of $500-$4,999 for serving as a study section member with NIH. Dr. Schiff has a non-compensated relationship as a Guidelines Panel Member with AAN that is relevant to AAN interests or activities.
Peter B. Forgacs, MD Dr. Forgacs has received personal compensation for serving as an employee of OVID Therapeutics Inc. Dr. Forgacs has received stock or an ownership interest from OVID Therapeutics Inc.