Quantitative Assessment of Burst Suppression As a Predictor of Seizure Recurrence in Refractory Status Epilepticus

Objective: To determine whether quantitative EEG analysis of burst suppression can predict seizure recurrence in patients with refractory status epilepticus (RSE) being treated with anesthetic doses of con-tinuous IV antiseizure medications (cIVASM).Methods: Quantitative assessment of burst suppression (including epileptiform discharges [EDs] and evo-lution) in 31 occasions (from 27 patients), and correlation with seizure recurrence up to 48 hours post sedative wean.Results: Occasions resulting in seizure recurrence (vs. no seizure recurrence) had lower burst (8.4 vs. 10.6 lV) and interburst interval (IBI) (4.2 vs. 4.8 lV) average amplitude, duration (bursts 2.8 vs. 3.6 s: IBIs 3.6 vs. 4.4 s); and burst total power (0.4 vs. 0.7 lV2). Bursts (0.86 vs. 0.60) and IBIs (0.28 vs. 0.07) with EDs, higher number of EDs within bursts (mean 2.1 vs. 1.4) and IBIs (0.6 vs. 0.2), and positive evo-lution measures all predicted seizure recurrence, although EDs had the greatest adjusted odds ratio on multivariate analysis. Conclusions: For patients in burst suppression, successful wean of cIVASM was not determined by classi-cal burst suppression measures, but instead how "epileptiform" bursts and IBIs were, as determined by EDs in both bursts and IBIs and surrogates for evolution within bursts. Significance: If confirmed, these objective measures could be used during clinical care to help determine when to wean cIVASM in patients with RSE.(c) 2023 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.