From the Department of Neurology (E.A.), Weill Institute for Neurosciences, University of California, San Francisco; Department of Neurology (E.A., W.-L.Z., J.J., M.B.W.), Massachusetts General Hospital, Boston; Department of Computer Science and Engineering (W.-L.Z.), Shanghai Jiao Tong University, China; Department of Neurology (J.J., T.P., M.B.W.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Computer Science and Engineering (M.M.G.), Michigan State University, East Lansing; Department of Neurology (J.W.L.), Brigham and Women's Hospital; Athinoula A. Martinos Center for Biomedical Imaging (O.W.), Department of Radiology, Massachusetts General Hospital, Boston; Department of Neurology (S.T.H.), Barrow Neurological Institute Comprehensive Epilepsy Center, Phoenix, AZ; Department of Neurology (A.S., N.G., L.H.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.G.), Universite Libre de Bruxelles, Belgium; Clinical Neurophysiology Group (B.J.R., M.C.T.-C., J.H., M.J.A.M.v.P.), University of Twente, Enschede; Department of Neurology (J.H.), Rijnstate Hospital, Arnhem; and Department of Neurology and Clinical Neurophysiology (M.J.A.M.v.P.), Medisch Spectrum Twente, Enschede, the Netherlands.
Neurology. 2023 Aug 29;101(9):e940-e952. doi: 10.1212/WNL.0000000000207537. Epub 2023 Jul 6.
Epileptiform activity and burst suppression are neurophysiology signatures reflective of severe brain injury after cardiac arrest. We aimed to delineate the evolution of coma neurophysiology feature ensembles associated with recovery from coma after cardiac arrest.
Adults in acute coma after cardiac arrest were included in a retrospective database involving 7 hospitals. The combination of 3 quantitative EEG features (burst suppression ratio [BSup], spike frequency [SpF], and Shannon entropy [En]) was used to define 5 distinct neurophysiology states: epileptiform high entropy (EHE: SpF ≥4 per minute and En ≥5); epileptiform low entropy (ELE: SpF ≥4 per minute and <5 En); nonepileptiform high entropy (NEHE: SpF <4 per minute and ≥5 En); nonepileptiform low entropy (NELE: SpF <4 per minute and <5 En), and burst suppression (BSup ≥50% and SpF <4 per minute). State transitions were measured at consecutive 6-hour blocks between 6 and 84 hours after return of spontaneous circulation. Good neurologic outcome was defined as best cerebral performance category 1-2 at 3-6 months.
One thousand thirty-eight individuals were included (50,224 hours of EEG), and 373 (36%) had good outcome. Individuals with EHE state had a 29% rate of good outcome, while those with ELE had 11%. Transitions out of an EHE or BSup state to an NEHE state were associated with good outcome (45% and 20%, respectively). No individuals with ELE state lasting >15 hours had good recovery.
Transition to high entropy states is associated with an increased likelihood of good outcome despite preceding epileptiform or burst suppression states. High entropy may reflect mechanisms of resilience to hypoxic-ischemic brain injury.
癫痫样活动和爆发抑制是反映心脏骤停后严重脑损伤的神经生理学特征。我们旨在描绘与心脏骤停后昏迷恢复相关的昏迷神经生理学特征组合的演变。
纳入 7 家医院回顾性数据库中急性心脏骤停后昏迷的成年人。使用 3 种定量脑电图特征（爆发抑制比[BSup]、尖波频率[SpF]和香农熵[En]）的组合来定义 5 种不同的神经生理学状态：癫痫样高熵（EHE：SpF≥4 次/分钟且 En≥5）；癫痫样低熵（ELE：SpF≥4 次/分钟且<5 En）；非癫痫样高熵（NEHE：SpF<4 次/分钟且≥5 En）；非癫痫样低熵（NELE：SpF<4 次/分钟且<5 En）和爆发抑制（BSup≥50%且 SpF<4 次/分钟）。在自主循环恢复后 6 至 84 小时内，以连续 6 小时块测量状态转换。良好的神经功能预后定义为 3-6 个月时最佳脑功能分类 1-2。
共纳入 1038 人（50224 小时脑电图），其中 373 人（36%）预后良好。EHE 状态的个体有 29%的良好预后率，而 ELE 状态的个体有 11%。从 EHE 或 BSup 状态向 NEHE 状态的转变与良好的预后相关（分别为 45%和 20%）。没有 ELE 状态持续>15 小时的个体有良好的恢复。
尽管先前存在癫痫样或爆发抑制状态，但向高熵状态的转变与良好预后的可能性增加相关。高熵可能反映了对缺氧缺血性脑损伤的弹性机制。
