RT Journal Article
SR Electronic
T1 Early EEG correlates of neuronal injury after brain anoxia
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP 796
OP 802
DO 10.1212/WNL.0b013e318249f6bb
VO 78
IS 11
A1 Rossetti, Andrea O.
A1 Carrera, Emmanuel
A1 Oddo, Mauro
YR 2012
UL http://n.neurology.org/content/78/11/796.abstract
AB Objectives: EEG and serum neuron-specific enolase (NSE) are used for outcome prognostication in patients with postanoxic coma; however, it is unclear if EEG abnormalities reflect transient neuronal dysfunction or neuronal death. To assess this question, EEG abnormalities were correlated with NSE. Moreover, NSE cutoff values and hypothermic EEG features related with poor outcome were explored. Methods: In a prospective cohort of 61 adults treated with therapeutic hypothermia (TH) after cardiac arrest (CA), multichannel EEG recorded during TH was assessed for background reactivity and continuity, presence of epileptiform transients, and correlated with serum NSE collected at 24–48 hours after CA. Demographic, clinical, and functional outcome data (at 3 months) were collected and integrated in the analyses. Results: In-hospital mortality was 41%, and 82% of survivors had good neurologic outcome at 3 months. Serum NSE and EEG findings were strongly correlated (Spearman rho = 0.45; p < 0.001). Median NSE peak values were higher in patients with unreactive EEG background (p < 0.001) and discontinuous patterns (p = 0.001). While all subjects with nonreactive EEG died, 5 survivors (3 with good outcome) had NSE levels >33 μg/L. Conclusion: The correlation between EEG during TH and serum NSE levels supports the hypothesis that early EEG alterations reflect permanent neuronal damage. Furthermore, this study confirms that absent EEG background reactivity and presence of epileptiform transients are robust predictors of poor outcome after CA, and that survival with good neurologic recovery is possible despite serum NSE levels> 33 μg/L. This underscores the importance of multimodal assessments in this setting. AAN=American Academy of Neurology; CA=cardiac arrest; CPC=Cerebral Performance Categories; FPR=false-positive rate; NSE=neuron-specific enolase; SIRPIDS=stimulus-induced rhythmic, periodic, or irritative discharges; SSEP=somatosensory evoked potentials; TH=therapeutic hypothermia; VF=ventricular fibrillation