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Electroencephalographic sleep patterns in post-anoxic stupor and coma.

Abstract

We analyzed EEGs performed over a 6-month period on patients with impaired consciousness following acute hypoxia or anoxia. There were 17 EEGs performed on 14 patients. Nine of the 17 records contained spindle activity. Spindles were present in 6/8 EEGs in stuporous patients, in 3/9 EEGs in comatose patients, in 6/10 patients who eventually died, and in 3/3 patients who regained consciousness. When spindle activity or background reactivity were absent, outcome was poor, ie, death or a persistent vegetative state. The presence of EEG spindle activity after hypoxic or anoxic injury did not indicate a favorable prognosis, but the absence of spindles or EEG background reactivity was associated with a poor outcome.

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BibTeXRIS

J F Hulihan, D R Syna. 1994. Electroencephalographic sleep patterns in post-anoxic stupor and coma.. https://doi.org/10.1212/wnl.44.4.758

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Predicting coma and other low responsive patients outcome using event-related brain potentials: a meta-analysis.

OBJECTIVE: A meta-analysis was performed to estimate the predictive power (odd ratio, OR) for awakening of auditory event-related potential (ERP) components in low responsive patients with stroke or hemorrhage, trauma, anoxic, post-operative, and metabolic encephalopathy etiologies. METHODS: We reviewed MEDLINE and analyzed citations for retrieved articles. Logistic regressions were applied on patient samples (Glasgow Coma Scale <12) across and for separate etiologies. RESULTS: For stroke and hemorrhage the ORs with 95% confidence intervals were: 2.05 [1.12-3.75] (N100), 4.47 [1.92-10.44] (MMN), 10.29 [2.00-52.79] (P300), for trauma: 1.63 [0.70-3.80] (N100), 4.72 [1.35-16.44] (MMN), 12.89 [4.82-34.43] (P300), anoxic: 8.03 [2.83-22.75] (N100), 15.50 [4.27-56.26] (MMN), 5.93 [2.38-14.77] (P300), post-operative: 10.66 [1.98-57.50] (N100), metabolic encephalopathy: 2.12 [0.34-13.13] (N100), 3.60 [0.28-46.36] (MMN), 7.71 [0.75-79.77] (P300), and all etiologies: 2.85 [1.91-4.27] (N100), 6.53 [3.55-12.01] (MMN), and 8.79 [4.88-15.83] (P300). Based on six N100 studies (N=548 patients), five MMN studies (N=470), and six P300 studies (N=313), the N100, MMN, or P300, when present, significantly predicted awakening, P300 and MMN being significantly better predictors than N100. CONCLUSIONS: The MMN and P300 appear to be reliable predictors of awakening. SIGNIFICANCE: The prognostic assessment of low responsive patients with auditory ERP should take into account both MMN and P300.

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