Ictal Burst Suppression: A Case Report and Brief Overview

In patients suffering catastrophic injury to the nervous system, a burst suppression pattern found on EEG is a rare finding. Usually, this pattern consists of bursts of mixed-frequency, variable-morphology waves alternating with suppressed periods and attenuation to an undetectable signal. This pattern can be difficult to assess, as burst suppression may be associated either with limited brain activity or with both clinical and electrographic seizures (ictal burst suppression). While this can occur at all ages, in adults it is most often seen with significant anoxic insult. We report a case of anoxic ictal burst suppression in a patient after cardiac arrest that was initially thought to represent anoxic myoclonus. Correlative clinical facial twitching and arm tonicity and flexion, which were abrogated by benzodiazepine and anesthetic administration, confirmed the ictal activity. Ictal burst suppression can be challenging both to recognize and to treat. We briefly review this phenomenon and the hypotheses regarding its potential mechanisms.