Highly Epileptiform Bursts Are Associated With Seizure Recurrence
Stephen A Thompson1, Stephen Hantus
1*Department of Neurology, University of Texas Health Science Center, Houston, Texas, U.S.A.; and†Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.
Summary
Highly epileptiform bursts (HEBs) on EEG may predict seizures in patients with burst suppression. This finding could guide sedation weaning in refractory status epilepticus, but further research is needed.
Area of Science:
- Neurophysiology
- Critical Care Medicine
- Epileptology
Background:
- Pharmacologic sedation is used for refractory status epilepticus, but evidence for weaning sedation is limited.
- The clinical significance of burst morphology in EEG is unclear.
- The American Clinical Neurophysiology Society introduced 'highly epileptiform bursts' (HEBs) terminology.
Purpose of the Study:
- To investigate the association between HEBs and subsequent seizure activity.
- To determine if HEBs can inform therapy for refractory status epilepticus.
Main Methods:
- Reviewed EEG records of adult patients with burst suppression (excluding anoxic etiology).
- Classified burst suppression as HEBs or nonepileptiform bursts using standardized terminology.
- Analyzed transitions out of burst suppression and subsequent EEG patterns (seizure or continuous slow EEG) within 24 hours.
Main Results:
- Twenty-four patients with 33 instances of burst suppression were analyzed.
- HEBs were significantly associated with subsequent seizure activity (P = 0.0001).
- This association was independent of medication exposure.
Conclusions:
- HEBs may predict recurrent seizures in patients with burst suppression.
- Further prospective studies are needed to confirm if HEBs can guide sedation weaning in status epilepticus.
Related Concept Videos
01:13Seizures: Classification
2.1K
Epilepsy is primarily characterized by unpredictable seizures, either provoked by an identifiable factor, such as injury or illness, or unprovoked, occurring spontaneously without apparent cause.
Seizures are typically classified into two main categories: focal and generalized seizures.
Focal Seizures
Focal seizures originate from specific regions of the brain. These seizures are further sub-classified into two types:
Seizures are typically classified into two main categories: focal and generalized seizures.
Focal Seizures
Focal seizures originate from specific regions of the brain. These seizures are further sub-classified into two types:
2.1K
01:24Epilepsy and Seizures: Overview
1.6K
Epilepsy is a chronic neurological disease marked by recurrent, unpredictable seizures. These seizures are caused by abnormal electrical discharges in the brain, leading to behavior, sensation, or consciousness alterations. They can also cause transient impairment of awareness, interfering with daily activities.
Various factors can trigger epilepsy, including genetic factors, brain damage, metabolic causes, and unknown etiology. Diagnosis of epilepsy involves electroencephalography (EEG), which...
Various factors can trigger epilepsy, including genetic factors, brain damage, metabolic causes, and unknown etiology. Diagnosis of epilepsy involves electroencephalography (EEG), which...
1.6K
01:20Antiepileptic Drugs: Modulators of Neurotransmitter Release Mediated by SV2A Protein
1.1K
Antiepileptic drugs, such as levetiracetam (Keppra) and brivaracetam (Briviact), have emerged as crucial tools in managing epilepsy. These medications exert their therapeutic effects by targeting the synaptic vesicle protein SV2A, a transmembrane glycoprotein primarily found in the brain.
SV2A is a transmembrane glycoprotein located predominantly in the brain, modulating the release of neurotransmitters for neuronal communication. Both levetiracetam and brivaracetam exhibit a high affinity for...
SV2A is a transmembrane glycoprotein located predominantly in the brain, modulating the release of neurotransmitters for neuronal communication. Both levetiracetam and brivaracetam exhibit a high affinity for...
1.1K
01:20Antiepileptic Drugs: Potassium Channel Activators
937
Ezocgabine or retigabine, an antiepileptic drug of remarkable efficacy, has revolutionized the management of seizures. It is a potassium channel activator, explicitly targeting the family of Q subtype potassium channels. It enhances the transmembrane potassium currents, regulating neuronal excitability. This action stabilizes the resting membrane potential, a pivotal factor in mitigating the hyperexcitability that characterizes epilepsy.
Ezogabine has gained approval as an adjunctive treatment...
Ezogabine has gained approval as an adjunctive treatment...
937
01:18Antiepileptic Drugs: GABAergic Pathway Potentiators
1.6K
γ-aminobutyric acid or GABA, plays a pivotal role as an inhibitory neurotransmitter in the brain. GABA pathway potentiators, also known as GABAergic drugs, are a class of pharmaceutical agents designed to enhance the functioning of the GABAergic system. These medications primarily treat epilepsy, a neurological disorder characterized by recurrent seizures.
The key GABA pathway potentiators used in epilepsy management are as follows.
Benzodiazepines are a well-known class of drugs used for...
The key GABA pathway potentiators used in epilepsy management are as follows.
Benzodiazepines are a well-known class of drugs used for...
1.6K
01:14Antiepileptic Drugs: Glutamate Antagonists
1.2K
Glutamate is a fundamental neurotransmitter in the central nervous system, playing a vital role in neuronal communication and various cognitive processes. Glutamate stands as the principal excitatory neurotransmitter in the brain. Its presence is crucial for the communication between neurons, underpinning essential processes such as synaptic transmission, neuronal excitability, and plasticity. These functions are vital for higher-order cognitive processes, including learning and memory. The...
1.2K