The following is a summary of “Association Between Induced Burst Suppression and Clinical Outcomes in Patients With Refractory Status Epilepticus,” published in the March 2023 issue of Neurology by Fisch, et al.
For a study, researchers sought to investigate the frequency of induced burst suppression patterns in the electroencephalogram (EEG) during continuous intravenous anesthesia (IVAD) and its association with outcomes in adult patients being treated for refractory status epilepticus (RSE).
The study included patients with RSE who received anesthetics at a Swiss academic care center between 2011 and 2019. Clinical data and semiquantitative EEG analyses were evaluated. Burst suppression was categorized as incomplete (with a suppression proportion of ≥20% and <50%) or complete (with a suppression proportion of ≥50%). In addition, the frequency of induced burst suppression and its association with outcomes, including persistent seizure termination, in-hospital survival, and return to premorbid neurologic function, were assessed.
A total of 147 patients with RSE treated with IVAD were identified. Among the 102 patients without cerebral anoxia, incomplete burst suppression was achieved in 14 patients (14%) with a median duration of 23 hours (interquartile range [IQR] 1-29), and complete burst suppression was achieved in 21 patients (21%) with a median duration of 51 hours (IQR 16-104). Age, Charlson comorbidity index, RSE with motor symptoms, Status Epilepticus Severity Score, and arterial hypotension requiring vasopressors were identified as potential confounders in univariable comparisons between patients with and without burst suppression.
However, multivariable analyses showed no associations between burst suppression patterns and predefined endpoints. In contrast, among the 45 patients with cerebral anoxia, induced burst suppression was associated with persistent seizure termination (72% without burst suppression vs. 29% with burst suppression, P = 0.004) and survival (50% without burst suppression vs. 14% with burst suppression, P = 0.005).
In adult patients with RSE treated with IVAD, approximately one in five patients achieved burst suppression with a suppression proportion of ≥50%. However, this burst suppression pattern was not associated with persistent seizure termination, in-hospital survival, or return to premorbid neurologic function. Induced burst suppression was associated with improved outcomes among patients with cerebral anoxia, including seizure termination and survival.