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Prognostically important EEG coma patterns in diffuse anoxic and traumatic encephalopathies in adults.

V M Synek1

  • 1Department of Clinical Neurophysiology, Auckland Hospital, New Zealand.

Journal of Clinical Neurophysiology : Official Publication of the American Electroencephalographic Society
|April 1, 1988
PubMed
Summary

A new electroencephalogram (EEG) grading scale helps predict survival after brain injury. This scale classifies EEG patterns, offering clearer prognostication for patients with diffuse traumatic and anoxic brain insults.

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Area of Science:

  • Neurophysiology
  • Neurology
  • Critical Care Medicine

Background:

  • Limited universally accepted electroencephalogram (EEG) grading scales exist for predicting survival after diffuse brain insults.
  • Existing scales lack detailed definitions for prognostically significant EEG patterns.

Purpose of the Study:

  • To present and discuss prognostically oriented EEG patterns, including recently described abnormalities, for diffuse traumatic and anoxic brain insults.
  • To establish a detailed EEG grading scale for improved survival prediction in coma patients.

Main Methods:

  • Classification of EEG patterns into five major grades based on an internationally accepted scale.
  • Detailed definition of individual patterns based on morphology, distribution, persistence, and reactivity to stimulation.

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  • Presentation of illustrative examples of key EEG patterns.

    • Main Results:

    • Favorable prognosis associated with Grade 1 and reactive Grade 2 abnormalities, preserved sleep features, and frontal monorhythmic delta activity.
    • Uncertain prognosis linked to nonreactive Grade 2, diffuse delta activity (Grade 3), and reactive alpha pattern coma.
    • Malignant prognosis suggested for persistent Grade 3 (low amplitude, irregular delta), Grade 4 (burst suppression, epileptiform discharges, low-output EEG), and Grade 5 (isoelectric EEG).
    • Fatal outcomes common with nonreactive alpha pattern coma and theta pattern coma.

    Conclusions:

    • The proposed detailed EEG subdivision enhances understanding and prognostication for coma patients.
    • This grading scale aids electroencephalographers in visual EEG assessment for improved patient outcome prediction.
    • The findings are applicable to coma from various etiologies with similar EEG features.