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Does burst-suppression achieve seizure control in refractory status epilepticus?
BACKGROUND: The general principles in the administration of anesthetic drugs entail not only the suppression of seizure activity but also the achievement of electroencephalography burst suppression (BS). However, previous studies have reported conflicting results, possibly owing to the inclusion of...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5910581/ https://www.ncbi.nlm.nih.gov/pubmed/29679985 http://dx.doi.org/10.1186/s12883-018-1050-3 |
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author | Phabphal, Kanitpong Chisurajinda, Suparat Somboon, Thapanee Unwongse, Kanjana Geater, Alan |
author_facet | Phabphal, Kanitpong Chisurajinda, Suparat Somboon, Thapanee Unwongse, Kanjana Geater, Alan |
author_sort | Phabphal, Kanitpong |
collection | PubMed |
description | BACKGROUND: The general principles in the administration of anesthetic drugs entail not only the suppression of seizure activity but also the achievement of electroencephalography burst suppression (BS). However, previous studies have reported conflicting results, possibly owing to the inclusion of various anesthetic agents, not all patients undergoing continuous electroencephalography (cEEG), and the inclusion of anoxic encephalopathy. This study aimed to analyze the effects of midazolam-induced BS on the occurrence outcomes in refractory status epilepticus patients. METHODS: Based on a prospective database of patients who had been diagnosed with status epilepticus via cEEG, multivariate Poisson regression modules were used to estimate the effect of midazolam-induced BS on breakthrough seizure, withdrawal seizure, intra-hospital complications, functional outcome at 3 months, and mortality. Modules were based on a pre-compiled directed acyclic graph (DAG). RESULTS: We included 51 non-anoxic encephalopathy, refractory status epilepticus patients. Burst suppression was achieved in 26 patients (51%); 25 patients (49%) had non-burst suppression on their cEEG. Breakthrough seizure was less often seen in the burst suppression group than in the non-burst suppression group. The incidence risk ratio [IRR] was 0.30 (95% confidence interval = 0.13–0.74). There was weak evidence of an association between BS and increased withdrawal seizure, but no association between BS and intra-hospital complications, mortality or functional outcomes was observed. CONCLUSION: This study provides evidence that BS is safe and associated with less breakthrough seizures. Additionally, it was not associated with an increased rate of intra-hospital complications or long-term outcomes. |
format | Online Article Text |
id | pubmed-5910581 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-59105812018-05-02 Does burst-suppression achieve seizure control in refractory status epilepticus? Phabphal, Kanitpong Chisurajinda, Suparat Somboon, Thapanee Unwongse, Kanjana Geater, Alan BMC Neurol Research Article BACKGROUND: The general principles in the administration of anesthetic drugs entail not only the suppression of seizure activity but also the achievement of electroencephalography burst suppression (BS). However, previous studies have reported conflicting results, possibly owing to the inclusion of various anesthetic agents, not all patients undergoing continuous electroencephalography (cEEG), and the inclusion of anoxic encephalopathy. This study aimed to analyze the effects of midazolam-induced BS on the occurrence outcomes in refractory status epilepticus patients. METHODS: Based on a prospective database of patients who had been diagnosed with status epilepticus via cEEG, multivariate Poisson regression modules were used to estimate the effect of midazolam-induced BS on breakthrough seizure, withdrawal seizure, intra-hospital complications, functional outcome at 3 months, and mortality. Modules were based on a pre-compiled directed acyclic graph (DAG). RESULTS: We included 51 non-anoxic encephalopathy, refractory status epilepticus patients. Burst suppression was achieved in 26 patients (51%); 25 patients (49%) had non-burst suppression on their cEEG. Breakthrough seizure was less often seen in the burst suppression group than in the non-burst suppression group. The incidence risk ratio [IRR] was 0.30 (95% confidence interval = 0.13–0.74). There was weak evidence of an association between BS and increased withdrawal seizure, but no association between BS and intra-hospital complications, mortality or functional outcomes was observed. CONCLUSION: This study provides evidence that BS is safe and associated with less breakthrough seizures. Additionally, it was not associated with an increased rate of intra-hospital complications or long-term outcomes. BioMed Central 2018-04-21 /pmc/articles/PMC5910581/ /pubmed/29679985 http://dx.doi.org/10.1186/s12883-018-1050-3 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Phabphal, Kanitpong Chisurajinda, Suparat Somboon, Thapanee Unwongse, Kanjana Geater, Alan Does burst-suppression achieve seizure control in refractory status epilepticus? |
title | Does burst-suppression achieve seizure control in refractory status epilepticus? |
title_full | Does burst-suppression achieve seizure control in refractory status epilepticus? |
title_fullStr | Does burst-suppression achieve seizure control in refractory status epilepticus? |
title_full_unstemmed | Does burst-suppression achieve seizure control in refractory status epilepticus? |
title_short | Does burst-suppression achieve seizure control in refractory status epilepticus? |
title_sort | does burst-suppression achieve seizure control in refractory status epilepticus? |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5910581/ https://www.ncbi.nlm.nih.gov/pubmed/29679985 http://dx.doi.org/10.1186/s12883-018-1050-3 |
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