Prognostic Value Of EEG Research Articles

“Creutzfeldt-Jacob disease or other rapidly progressive dementia? Diagnostic and prognostic value of EEG, brain MRI and CSF features”

The ante-mortem diagnosis of Creutzfeldt-Jacob disease (CJD) is challenging because of resemblance with other rapidly progressive dementia (RPD). Our study aimed to evaluate diagnostic and prognostic value of EEG, brain MRI and cerebrospinal fluid (CSF) features, currently representing CJD diagnostic criteria.

Prognostic value of \u2018late\u2019 electroencephalography recordings in patients with cardiopulmonal resuscitation after cardiac arrest

BackgroundElectroencephalography (EEG) significantly contributes to the neuroprognostication after resuscitation from cardiac arrest. Recent studies suggest that the prognostic value of EEG is highest for continuous recording within the first days after cardiac arrest. Early continuous EEG, however, is not available in all hospitals. In this observational study, we sought to evaluate the predictive value of a ‘late’ EEG recording 5–14 days after cardiac arrest without sedatives.MethodsWe retrospectively analyzed EEG data in consecutive adult patients treated at the medical intensive care units (ICU) of the Charité—Universitätsmedizin Berlin. Outcome was assessed as cerebral performance category (CPC) at discharge from ICU, with an unfavorable outcome being defined as CPC 4 and 5.ResultsIn 187 patients, a ‘late’ EEG recording was performed. Of these patients, 127 were without continuous administration of sedative agents for at least 24 h before the EEG recording. In this patient group, a continuously suppressed background activity < 10 µV predicted an unfavorable outcome with a sensitivity of 31% (95% confidence interval (CI) 20–45) and a specificity of 99% (95% CI 91–100). In patients with suppressed background activity and generalized periodic discharges, sensitivity was 15% (95% CI 7–27) and specificity was 100% (95% CI 94–100). GPDs on unsuppressed background activity were associated with a sensitivity of 42% (95% CI 29–46) and a specificity of 92% (95% CI 82–97).ConclusionsA ‘late’ EEG performed 5 to 14 days after resuscitation from cardiac arrest can aide in prognosticating functional outcome. A suppressed EEG background activity in this time period indicates poor outcome.

4047 EEG as a Predictor of Post-Stroke Recovery: A Systematic Review and Meta-Analysis

OBJECTIVES/GOALS: The objective of this study is to perform a systematic review and meta-analysis on the prognostic utility of electroencephalography (EEG) in stroke recovery. METHODS/STUDY POPULATION: A literature search was conducted using three electronic databases, including PubMed, Scopus, and CINAHL. Key search terms were “EEG,” “stroke,” and “rehabilitation”. Only peer-reviewed journal articles published in English that examined the relationship between EEG and a standardized clinical outcome measure(s) at a later time in stroke patients were included. Two independent raters completed data extraction and assessed methodological quality of the studies with the Downs and Black form. A linear meta-regression was performed across subsets of individual studies that utilized a common clinical outcome measure to determine the association between EEG and clinical outcome while adjusting for sample size and study quality. RESULTS/ANTICIPATED RESULTS: 56 papers met the inclusion criteria and were included in the systematic review. The prognostic value of EEG was evidenced at both the acute and chronic stages of stroke. The addition of EEG enhanced prognostic accuracy more than initial clinical assessment scores and/or lesion volume alone. In the meta-analysis, a subset of 10 papers that utilized the National Institutes of Health Stroke Scale (NIHSS) and a subset of 7 papers that utilized the Modified Rankin Scale (MRS) were included. Analysis demonstrated an association between EEG and the subsequent clinical outcome measures. DISCUSSION/SIGNIFICANCE OF IMPACT: Currently, prognosis is largely based on initial behavioral impairment level. However, post-stroke recovery outcomes are heterogeneous despite similar initial clinical presentations. Uncertain prognosis makes it difficult for clinicians to develop personalized treatment plans for patients. Improved prognosis for recovery may guide clinical management for stroke survivors by helping clinicians determine the maximally efficient course of treatment and care. This study suggests that prognostic accuracy may be enhanced using EEG.

S26. Description and prognostic value of EEG in patients in coma after recovered cardiorespiratory arrest

Introduction Postanoxic coma after cardiac arrest is one of the most serious acute cerebral conditions and a frequent cause of admission to critical care units, wherefore is necessary the use of accurate methods for diagnosis and prognosis. In addition to the classic neurologic examination, EEG is increasingly emerging as an important tool to assess cerebral functions in a non-invasive way because is a sensitive method for evaluating patients with anoxic-ischaemic encephalopathy due to cardiorrespiratory arrest (CRA) and provides accurate prognostic information in the early phase of coma however, its specificity is affected by the action of sedative drugs and the variability inter-observers. The EEG shows several patterns that may be useful for the prognosis and possible progression of patients with post-CRA coma. The aim of this study is to describe the morphology and analyze the prognostic value of the EEG patterns and reactivity to stimuli in post-CRA coma patients. Methods 45 patients with CRA were analyzed. The variables established in the study included age, sex, pathological history, time of CRA, cause of CRA, therapeutic hypothermia, EEG (pattern and reactivity) and clinical development. All EEG studies were done without sedation drugs at least for 8 h and 24 h after therapeutic hypothermia (TH). Results The initial EEG and the control EEGs in the patients were analyzed and an attempt was made to establish a correlation between the various EEG patterns and the clinical evolution of the patients. Surprisingly, the EEG reactivity was the parameter that, in isolation, presented greater specificity in our series. Conclusion The EEG provides early information on brain function and prognosis in the context of a multimodal assessment of coma patients with recovered CRA. The standardization in the nomenclature of the EEG patterns following the terminology of the ACNS helps the easy recognition of these patterns and their correlation with the prognosis. It is essential to evaluate reactivity in this patients, given that this seems to be the most relevant data when estimating a prognosis.

10. Neurophysiological prognosis in comatose patients after cardiac arrest: The Italian Multicentric Study (ProNeCA)

SEPs are reliable predictor of poor outcome in comatose patients after cardiac arrest (CA). Recently also the role of EEG has been reassessed. To evaluate the prognostic value of EEG and SEPs association in post-anoxic coma at different recording time. We included comatose patients after CA. EEG and SEPs were recorded within 12 hs and at 72 hs after CA. EEG was classified into grade 1(“continuous”/“nearly-continuous”) and grade 2(discontinuous/burst-suppression/suppression/isoelectric). SEPs were dichotomized into “bilaterally absent” (BA) and “present”. Outcome was evaluated at 6 months by GOS. “Recovery of consciousness” was considered good outcome. Ten centers took part to the study and 282 patients were included. EEG and SEPs were recorded in 141 within 12 hs in 162 at 72 hs. Grade 1 EEG at 12 hs always predicted good outcome, grade 2 pattern at 72 hs predicted poor outcome with higher predictive power. BA SEPs always predicted poor outcome. Grade 1 EEG was always associated with present SEPs. EEG is a reliable time-dependent predictor of good outcome (within 12 h) and poor outcome (after 72 h). SEP is time-independent predictor of poor outcome. Early grade 1 EEG is never associated with BA SEP. Early association recordings of EEG and SEPs increase of the reliability of prognosis prediction in post-anoxic coma.

O80 Neurophysiological prognosis in comatose patients after cardiac arrest: The italian multicentric study (PRONECA) – preliminary data-

Objective To evaluate the prognostic value of EEG and SEPs association in post-anoxic comatose patients at different recording time from cardiac arrest (CA) a italian multicentric study. Methods Comatose patients after CA were included.EEG and SEPs were recorded within 12 h and at 72 h after CA. EEG was classified into “non-continuous” (low voltage, isoelectric, burst-suppression) and “continuous” (other patterns except epileptiform). SEPs were dichotomized into “bilaterally absent” (BA) and “present”. Outcome was evaluated at 6 months by GOS. “Recovery of consciousness” was considered good outcome. Results At the moment four center took part to the study and 230 patients were included. EEG and SEPs were recorded in 92 within 12 h in 102 at 72 h. “Continuous” EEG pattern at 12 h always predicted good outcome, “non-continuous” pattern at 72 h always predicted poor outcome. BA SEPs always predicted poor outcome. Early “continuous” EEG pattern was always associated with present SEPs. Conclusion EEG is a reliable time-dependent predictor of good outcome (within 12 h) and poor outcome (after 72 h). SEP is time-independent predictor of poor outcome. Early “continuous” EEG and BA SEPs are never associated together. Significance The combination of EEG/SEP findings allows prediction of good and poor outcome (within 12 h after CA) and of poor outcome (after 48–72 h). Recording of EEG and SEPs in the same patients allows always an increase in the number of cases correctly classified and an increase of the reliability of prognostication in a single patient due to concordance of patterns.

12. Outcome prediction in comatose patients after cardiac arrest, the utility of early EEG/SEP recordings during therapeutic hypothermia: The italian multicentric study (PRONECA) preliminary data

Somatosensory evoked potentials(SEPs) and EEG are reliable outcome predictors of coma after cardiac arrest (CA). Nevertheless, only few multicentric studies are available. Aim of the study was to evaluate the prognostic value of EEG and SEPs association in post-anoxic comatose patients at different recording time from cardiac arrest (CA) in an Italian multicentric study. Comatose patients after CA treated with TH were included. EEG and SEPs were recorded within 12 h and at 72 h after CA. EEG was classified into “non-continuous” and “continuous”. SEPs were dichotomized into “bilaterally absent” (BA) and “present”. Neurologic outcome was evaluated at 6 months by GOS: “awakening”(GOS 3–5) was considered good outcome. 83 patients were included to date. “Continuous” EEG pattern at 12 h always predicted good outcome, “non-continuous” pattern at 72 h always predicted poor outcome. BA SEPs always predicted poor outcome. Early “continuous” EEG pattern was always associated with present SEPs. SEPs provide a specific and time-independent predictor of poor outcome. EEG provide a specific and time-dependent predictor of good outcome (at

80. EEG is a time-dependent reliable indicator of good or poor outcome in comatose patients after cardiac arrest

The prognostic role of EEG during early phase after cardiac arrest (CA) has been recently emphasized, but different classifications and definitions have been employed among studies. A standardized terminology for ICU patients has been recently proposed by American Clinical Neurophysiology Society (ACNS). We retrospectively evaluated the prognostic value of EEG according to different times of recording in postanoxic comatose patients, classifying EEGs according to the ACNS terminology with a main focus on background continuity. The study included EEG of 211 patients, recorded at 12, 24, 48 and 72 h. At each timing we observed at least one EEG pattern with specificity of 100% for poor or good outcome. At 12 h “continuous” and “nearly continuous” EEGs were always associated to good outcome, whereas isoelectric EEG and “burst-suppression with highly epileptiform discharges” were always associated to poor outcome. At 24 h isoelectric and all “burst-suppression” EEGs were always associated to poor outcome. At 48 h and 72 h isoelectric, “burst-suppression” and “suppressed” (

78. Diagnostic accuracy of neurophysiological tests (EEG and SEP) in comatose patients after cardiac arrest: Protocol presentation of Italian Multicentric Study (ProNeCA)

The prediction of neurologic outcome in comatose patients after cardiac arrest (CA) has been investigated and the findings were summarized in a practice parameter of the American Academy of Neurology (1). These guidelines did not include the EEG as a reliable outcome indicator but recent studies on continuous EEG recorded during TH have re-evaluated the role of EEG (2–4). These studies underline the utility of a simplified classification system of EEG patterns and point to which pattern attains reliable predictive value both for good and bad outcomes. These reports are of high clinical relevance because, until today, the possibility of identifying early prognostic indicators of good outcome in patients surviving to CA has not been investigated. At the best of our knowledge, only few multicentre prospective studies (4–6) analyzed the prognostic value of EEG and SEP recorded in the same patient after CA as single predictor but none analyzed the diagnostic accuracy of the association of these two tests. We present the study protocol of Italian Multicentre Study about prognostic value of EEG and SEP in comatose patients after CA (ProNeCA) proposed by study group of “Intraoperative and Intensive Care Clinical Neurophysiology” of the Italian Society of Clinical Neurophysiology.

EEG for Diagnosis and Prognosis of Acute Nonhypoxic Encephalopathy: History and Current Evidence.

The term encephalopathy encompasses a wide variety of complex syndromes caused by a large number of different toxic, metabolic, infectious, and degenerative derangements. Acute encephalopathy typically presents with a fluctuating course involving alteration of mental status or confusion and decreased (or rarely increased) motor activity. There usually are lethargy, cognitive impairment, altered memory and mental processing of information, and disturbed sleep-wake cycles. Encephalopathy mainly occurs in the elderly and is frequently encountered in intensive care units and postoperatively. Despite new diagnostic procedures and advances in intensive medical care, acute encephalopathy constitutes a significant cause of morbidity and mortality in hospitalized patients. EEG enables rapid bedside electrophysiological monitoring providing dynamic real-time information on neocortical brain activity and dysfunction. Hence, EEG complements clinical and neuroimaging assessments of encephalopathic patients. Progressive slowing of EEG background activity with increasing cerebral compromise, the emergence of episodic electrographic transients, seizures, and decreased EEG reactivity to external stimuli provide important diagnostic and prognostic information. The aim of this review was to provide a comprehensive overview of the current evidence for the diagnostic and prognostic value of EEG in adult intensive care unit patients with acute nonhypoxic encephalopathy.

2. EEG predictors of outcome in patients with disorders of consciousness

Although standard EEG is performed routinely in patients with severe disorders of consciousness, little is known about the prognostic value of its classical descriptors (i.e., amplitude, frequency, and reactivity). This study examined the prognostic value of EEG in patients with severe disorders of consciousness, and generated a novel clinical scoring system to utilize its descriptors prognostically. EEGs recorded at admission in 106 patients were analyzed retrospectively. EEG amplitude, frequency, and reactivity to stimuli were correlated to patient outcomes according to the Coma Recovery Scale Revised (CRS-R) at 3 months after admission. Data were integrated to generate a novel Amplitude–Frequency–Reactivity (AFR) scale. Patients with reduced amplitudes showed less improvement at 3 months compared to patients with normal amplitudes. Alpha, theta, and delta frequencies were associated with the greatest, intermediate, and the least improvement, respectively. Patients with EEG reactivity showed greater improvement. The AFR scores for these patients were also significantly correlated with outcomes. Reduced EEG amplitudes and delta frequencies correlated with poor clinical outcomes, while alpha frequencies and reactivity correlated with positive outcomes. AFR scores of 3 and 4 were predictive of poor outcomes, while scores of 6 and 7 were predictive of positive outcomes.

P478: Prediction of good and poor outcome in comatose patients after cardiac arrest: the utility of early EEG/SEP recordings during therapeutic hypothermia

To evaluate the prognostic value of EEG and SEPs in post-anoxic comatose patients at 12 h, 24 h and 72 h from cardiac arrest (CA). Comatose patients after CA treated with TH were included. EEG and SEPs were recorded within 12 h, 24 h and 72 h after CA. EEG was classified into “non-continuous” (low voltage, isoelectric, burst-suppression) and “continuous” (other patterns except epileptiform). SEPs were dichotomized into “bilaterally absent” (BA) and “present”. Neurologic outcome was evaluated at 6 months by GOS: “awakening” (GOS 3–5) was considered good outcome. EEG and SEPs were recorded in 147 patients, 33 of whom within 12 h. “Continuous” EEG pattern at 12 h always predicted good outcome, “non-continuous” pattern at 72 h always predicted poor outcome. BA SEPs always predicted poor outcome. Early “continuous” EEG pattern was always associated with present SEPs. SEPs provide a specific and time-independent predictor of poor outcome (bilateral absence). EEG provide a specific and time-dependent predictor of good outcome (“continuous” pattern at

Clinical and Electroencephalographic Correlates of Acute Encephalopathy

The term encephalopathy encompasses a wide variety of syndromes caused by a large number of different toxic, metabolic, and degenerative derangements. Despite advances in intensive medical care and new diagnostic procedures, encephalopathy remains a frequent and underrecognized critical medical condition with high morbidity and mortality. Electroencephalography (EEG) enables rapid bedside electrophysiological measurements of brain dysfunction and complements clinical and neuroimaging assessment of encephalopathic patients. Both progressive slowing of EEG background activity with increasing cerebral compromise and decreased EEG reactivity to external stimuli provide important diagnostic and prognostic information. The aim of this review was to provide an overview of the diagnostic and prognostic value of EEG in encephalopathic patients.

Prognostic value of electroencephalography and evoked potentials in the early course of malignant middle cerebral artery infarction

Space-occupying brain edema may lead to a malignant course in patients with large middle cerebral artery infarction. Decompressive hemicraniectomy has to be initiated early to prevent further tissue damage. In this retrospective study, we analyzed electroencephalography (EEG) and evoked potentials (EPs), obtained within 24 h after onset of stroke, in 22 patients suffering from a large middle cerebral artery infarction. Our findings indicate a prognostic value of EEG and brainstem auditory EP (BAEP): the absence of delta activity and the presence of theta and fast beta frequencies within EEG-focus predicted a non-malignant course. In contrast, diffuse generalized slowing and slow delta activity in the ischemic hemisphere pointed to a malignant course. Likewise, pathological BAEP were correlated with a malignant course. The coexistence of background slowing and pathological BAEP showed the highest level of significance. In conclusion, our findings implicate an additional early application of electrophysiological methods in stroke patients. EEG and EP deliver useful information to select those patients who develop malignant edema.

Usefulness of Standard EEG in Predicting the Outcome of Patients With Disorders of Consciousness After Anoxic Coma

Although standard EEG is performed routinely in patients with disorders of consciousness after coma, its prognostic value is still debated. The aim of the present study was to evaluate the role of standard EEG in predicting the recovery of cognitive functioning in patients affected by severe disturbances of consciousness after coma caused by cerebral anoxia. A standard EEG was recorded at admission to our Rehabilitation Department in 15 patients experiencing impaired consciousness because of cerebral anoxia. We quantified EEG abnormalities using the Synek scale (1988). Cognitive functioning was measured with the levels of cognitive functioning scale at the time of admission and after 3 months of recovery. EEG scores were significantly correlated with both levels of cognitive functioning scores at admission (P = 0.004) and change in levels of cognitive functioning score after 3 months (P < 0.001). The first correlation confirms the relationship between EEG and cognitive functioning, while the second correlation indicates the prognostic value of EEG in cognitive outcome. In conclusion, standard EEG is a simple and readily available tool with significant prognostic value in patients with disorders of consciousness after coma caused by cerebral anoxia.

The prognostic value of EEG in children with minor head trauma

The prognostic value of EEG in children with minor head trauma

Prognostic Value of EEG in Asphyxiated Newborns Treated with Hypothermia

Researchers at Children’s Hospitals in Milan, Italy, determined the prognostic value of electroencephalographic patterns in 23 newborns with severe perinatal hypoxic-ischemic encephalopathy, treated with hypothermia.

Prognostic value of EEG performed at term age in preterm infants

Electroencephalography (EEG) was performed at term age on 32 infants born prematurely (25-32 weeks). EEG was assessed looking for overall background activity and transients. A quantitative analysis was performed, selecting 5-min epochs of "tracé alternant" free of artefacts during quiet sleep. EEG findings were compared with cranial ultrasound (US) findings at term age and with neurodevelopmental outcome at 2 years (Student's t-test). The overall EEG background activity was not always related to the outcome or to the severity of cranial US. Infants with normal US and normal outcome had longer synchrony percentage of bursts, longer maximum duration of bursts and shorter mean of abnormal transients per interbursts than children with major lesions and abnormal outcome. Infants with minor lesions, who all had normal outcome, also had better results than those with major lesions and abnormal outcome, but the range of the EEG findings was more variable. Our results suggest that the EEG performed at term age does not provide additional prognostic information compared to cranial US.

Prognostic value of EEG in post-anoxic coma after cardiac arrest.

The authors themselves studied 26 patients. The EEGs were classified in terms of increasing severity in 5 categories. Incorporating over 400 cases from the literature, the authors correlated the initial EEG findings with the clinical outcome following cardiac arrest. Grade I EEG findings (normal alpha with theta-delta activity) imply a very good prognosis. A complete remission can be expected in most cases. Grade II (dominant theta-delta activity with detectable normal alpha) and grade III (dominant theta-delta activity without detectable normal alpha) findings have no definite prognosis. Grade IV [low-voltage delta, possibly with short isoelectric intervals; dominant, monomorphic, non-reactive alpha-activity (alpha coma); periodic generalized phenomena (spikes, sharp waves, slow waves with very low background activity)] and grade V (very flat to isoelectric EEG) findings have a very serious prognosis.

The prognostic value of EEG in coma survivors after cardiac arrest.

EEG was recorded in 64 patients while they were in a state of moderate coma after cardiac arrest. The clinical course of the patients was followed, and the prognosis was compared with the EEG findings.A total of 59 patients died within periods ranging from 1 to 287 days, 57 without having regained consciousness. Five patients survived, all with cerebral sequelae. The immediate causes of death were brain death in 18, pneumonia in 24, and cardiovascular complications in 17 cases. Autopsy was performed in 54 patients.The EEGs were visually graded and classified into five groups, in order of increasing abnormalities (Hockaday et al. 1965). Of the records, 17% were unclassifiable. An extremely abnormal EEG (grade V) was indicative of death after a few days, while other grades of EEG changes did not give any prognostic indications. Good correlation was disclosed by multiple regression analysis between the length of the survival time and the EEG changes estimated on the basis of 12 variables.A method is described by which it is possible to estimate the probable length of survival of a patient from his EEG records. There was a fair correlation between the estimated and observed survival times, except in the patients who died from cardiovascular complications after a few days. In these cases the prediction from the EEG was too optimistic.It is concluded that EEG is a useful supplement to the clinical evaluation of patients in coma after cardiac arrest. The EEG must be assessed in a special way, as simple visual grading is of only limited prognostic value.