Prognostic value of standard EEG in traumatic and non-traumatic disorders of consciousness following coma

OBJECTIVE To investigate the prognostic value of standard electroencephalogram (EEG) in predicting the improvement of the level of consciousness in patients suffering from severe disturbances of consciousness following coma caused by acute brain injuries. METHODS A standard EEG was recorded at admission in our rehabilitation department in a total of 46 patients with impaired consciousness states following coma (22 patients with traumatic brain injuries, 24 patients with non-traumatic brain injuries). We quantified the EEG abnormalities using the scale of Synek (1988) and correlated them with the basal level of cognitive functioning (LCF) scale score and with its variation after three months. RESULTS EEG scores correlated with LCF scores at admission (p<0.01) and with LCF scores' variation after three months (p<0.01) in patients with traumatic brain injury; EEG scores correlated only with LCF scores variation after three months (p<0.01) in patients with non-traumatic brain injury. CONCLUSIONS Standard EEG, analysed using the Synek scale, has a good prognostic value in both groups of patients with disorders of consciousness. SIGNIFICANCE This work may have implications for clinical care, rehabilitative programs and medical-legal decisions in patients with impaired consciousness states following coma due to acute brain injuries.

[1]  F H Duffy,et al.  Age‐related differences in brain electrical activity of healthy subjects , 1984, Annals of neurology.

[2]  Steven Laureys,et al.  Cerebral response to patient's own name in the vegetative and minimally conscious states , 2007, Neurology.

[3]  J. Adams,et al.  Neuropathology in vegetative and severely disabled patients after head injury , 2001, Neurology.

[4]  J. Adams,et al.  The neuropathology of the vegetative state after an acute brain insult. , 2000, Brain : a journal of neurology.

[5]  C. Fischer,et al.  [Traumatic brain injuries in adults: from coma to wakefulness. Neurophysiological data]. , 2002, Annales de readaptation et de medecine physique : revue scientifique de la Societe francaise de reeducation fonctionnelle de readaptation et de medecine physique.

[6]  A. Owen,et al.  Neuroimaging and the Vegetative State , 2009, Annals of the New York Academy of Sciences.

[7]  B. de Gelder,et al.  Mismatch negativity predicts recovery from the vegetative state , 2007, Clinical Neurophysiology.

[8]  D K Menon,et al.  Neurometabolic coupling in the vegetative and minimally conscious states: preliminary findings , 2005, Journal of Neurology, Neurosurgery & Psychiatry.

[9]  Multi-Society Task Force on Pvs Medical aspects of the persistent vegetative state (1). , 1994, The New England journal of medicine.

[10]  Synek Vm,et al.  Prognostically important EEG coma patterns in diffuse anoxic and traumatic encephalopathies in adults. , 1988 .

[11]  P. Kaplan,et al.  Clinical correlates and prognosis in early spindle coma , 2000, Clinical Neurophysiology.

[12]  T. Landis,et al.  EEG reactivity in the prognosis of severe head injury , 1995, Neurology.

[13]  P. Kaplan,et al.  Etiology, neurologic correlations, and prognosis in alpha coma , 1999, Clinical Neurophysiology.

[14]  B Jennett,et al.  Disability after severe head injury: observations on the use of the Glasgow Outcome Scale. , 1981, Journal of neurology, neurosurgery, and psychiatry.

[15]  Matthew H. Davis,et al.  Detecting awareness in the vegetative state. , 2006, Science.

[16]  P. Onorati,et al.  An unexpected recovery from permanent vegetative state , 2007, Brain injury.

[17]  A. Ragazzoni,et al.  Prediction of ‘awakening’ and outcome in prolonged acute coma from severe traumatic brain injury: evidence for validity of short latency SEPs , 2005, Clinical Neurophysiology.

[18]  R. Cranford,et al.  Clinical diagnosis of prolonged states of impaired consciousness in adults. , 2005, Mayo Clinic proceedings.

[19]  Foss Mv MANAGEMENT OF VIRUS HEPATITIS. , 1964 .

[20]  D. Galanaud,et al.  Exploring Altered Consciousness States by Magnetic Resonance Imaging in Brain Injury , 2009, Annals of the New York Academy of Sciences.

[21]  B. Fauvage,et al.  Isoelectric electroencephalogram and loss of evoked potentials in a patient who survived cardiac arrest. , 1993, Critical care medicine.

[22]  M J McKeown,et al.  Alpha, theta and alpha-theta coma: a clinical outcome study utilizing serial recordings. , 1994, Electroencephalography and clinical neurophysiology.

[23]  J. Giacino,et al.  The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility. , 2004, Archives of physical medicine and rehabilitation.

[24]  F. Plum,et al.  Persistent vegetative state after brain damage. A syndrome in search of a name. , 1972, Lancet.

[25]  J. Giacino,et al.  The minimally conscious state: Definition and diagnostic criteria , 2002, Neurology.

[26]  R. Piperno,et al.  Late recovery from post-traumatic vegetative state , 2009, Brain injury.

[27]  B. Kotchoubey,et al.  Predicting coma and other low responsive patients outcome using event-related brain potentials: A meta-analysis , 2007, Clinical Neurophysiology.

[28]  B. Jennett,et al.  ASSESSMENT OF OUTCOME AFTER SEVERE BRAIN DAMAGE A Practical Scale , 1975, The Lancet.

[29]  Frank H. Duffy,et al.  The pattern of age-related differences in electrophysiological activity of healthy males and females , 1993, Neurobiology of Aging.

[30]  J. Beaumont,et al.  Incidence and prevalence of the vegetative and minimally conscious states , 2005, Neuropsychological rehabilitation.