Prognostic value of post-acute EEG in severe disorders of consciousness, using American Clinical Neurophysiology Society terminology

The Intensive Rehabilitation Unit Study Group of the IRCCS Don Gnocchi Foundation, Italy

Research output: Contribution to journalArticle

Abstract

Objective: To evaluate whether electroencephalographic (EEG) features recorded during the post-acute stage in patients with severe disorders of consciousness (DoC) after acute brain injury (ABI), contribute to neurological outcome prediction of these patients at discharge from the intensive rehabilitation unit (IRU). Methods: We retrospectively evaluated all patients consecutively admitted to the IRU from August 2012 to December 2016. Inclusion criteria were: 1) age > 18years, 2) patients with unresponsive wakefulness syndrome (UWS) or in a minimally conscious state (MCS), and 3) EEG and a coma recovery scale-revised (CRS-R) score available within the first week after admission. Clinical evaluation was performed using the Italian version of the CRS-R score. EEGs were classified according to American Clinical Neurophysiology Society (ACNS) terminology. Clinical state at final discharge was evaluated using the CRS-R score. Results: In total, 102 patients were included in the analysis. After a mean of five months of IRU stay, among the 61 UWS subjects, 19 transitioned to MCS and 11 recovered to exit-MCS (E-MCS); twenty-three of the 41 subjects in MCS progressed to E-MCS. Using logistic regression, consciousness level (UWS/MCS-OR = 13.4), CRS-R score at admission (OR = 1.33) and use of activating drugs (OR = 4.7) were significant predictors of clinical improvement. Multivariable analysis showed that specific EEG patterns were independent predictors of improved consciousness at discharge in UWS patients. Discussion: EEG performed within the first week after IRU admission, classified according to ACNS-terminology in patients with UWS at admission, can provide useful prognostic contribution.

Original languageEnglish
JournalNeurophysiologie Clinique
DOIs
Publication statusPublished - Jan 1 2019

Fingerprint

Consciousness Disorders
Neurophysiology
Persistent Vegetative State
Terminology
Wakefulness
Coma
Rehabilitation
Consciousness
Patient Discharge
Brain Injuries
Electroencephalography
Logistic Models
Pharmaceutical Preparations

Keywords

  • CRS-r
  • Disorder of consciousness
  • EEG
  • MCS
  • Prognosis

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Physiology (medical)

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Prognostic value of post-acute EEG in severe disorders of consciousness, using American Clinical Neurophysiology Society terminology. / The Intensive Rehabilitation Unit Study Group of the IRCCS Don Gnocchi Foundation, Italy.

In: Neurophysiologie Clinique, 01.01.2019.

Research output: Contribution to journalArticle

The Intensive Rehabilitation Unit Study Group of the IRCCS Don Gnocchi Foundation, Italy. / Prognostic value of post-acute EEG in severe disorders of consciousness, using American Clinical Neurophysiology Society terminology. In: Neurophysiologie Clinique. 2019.
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abstract = "Objective: To evaluate whether electroencephalographic (EEG) features recorded during the post-acute stage in patients with severe disorders of consciousness (DoC) after acute brain injury (ABI), contribute to neurological outcome prediction of these patients at discharge from the intensive rehabilitation unit (IRU). Methods: We retrospectively evaluated all patients consecutively admitted to the IRU from August 2012 to December 2016. Inclusion criteria were: 1) age > 18years, 2) patients with unresponsive wakefulness syndrome (UWS) or in a minimally conscious state (MCS), and 3) EEG and a coma recovery scale-revised (CRS-R) score available within the first week after admission. Clinical evaluation was performed using the Italian version of the CRS-R score. EEGs were classified according to American Clinical Neurophysiology Society (ACNS) terminology. Clinical state at final discharge was evaluated using the CRS-R score. Results: In total, 102 patients were included in the analysis. After a mean of five months of IRU stay, among the 61 UWS subjects, 19 transitioned to MCS and 11 recovered to exit-MCS (E-MCS); twenty-three of the 41 subjects in MCS progressed to E-MCS. Using logistic regression, consciousness level (UWS/MCS-OR = 13.4), CRS-R score at admission (OR = 1.33) and use of activating drugs (OR = 4.7) were significant predictors of clinical improvement. Multivariable analysis showed that specific EEG patterns were independent predictors of improved consciousness at discharge in UWS patients. Discussion: EEG performed within the first week after IRU admission, classified according to ACNS-terminology in patients with UWS at admission, can provide useful prognostic contribution.",
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AU - Lolli, Francesco

AU - Hakiki, Bahia

AU - Atzori, Tiziana

AU - Lanzo, Giovanni

AU - Sterpu, Raisa

AU - Portaccio, Emilio

AU - Romoli, Anna Maria

AU - Morrocchesi, Azzurra

AU - Amantini, Aldo

AU - Macchi, Claudio

AU - Grippo, Antonello

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