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Annals of Intensive Care
Published in: Annals of Intensive Care 1/2023

Open Access 01-12-2023 | Herpes Virus | Research

Electroencephalography for prognostication of outcome in adults with severe herpes simplex encephalitis

Authors: Lina Jeantin, Claire Dupuis, Geoffroy Vellieux, Pierre Jaquet, Etienne de Montmollin, Jean-François Timsit, Romain Sonneville, the ENCEPHALITICA Study Group

Published in: Annals of Intensive Care | Issue 1/2023

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Abstract

Background

Electroencephalography (EEG) is recommended for the practical approach to the diagnosis and prognosis of encephalitis. We aimed to investigate the prognostic value of standard EEG (stdEEG) in adult patients with severe herpes simplex encephalitis.

Methods

We performed a retrospective analysis of consecutive ICU patients with severe herpes simplex encephalitis in 38 French centers between 2006 and 2016. Patients with at least one stdEEG study performed at ICU admission were included. stdEEG findings were reviewed independently by two investigators. The association between stdEEG findings (i.e., background activity, lateralized periodic discharges, seizures/status epilepticus, and reactivity to painful/auditory stimuli) and poor functional outcome, defined by a score on the modified Rankin Scale (mRS) of 3 to 6 (moderate to severe disability or death) at 90 days, were investigated.

Results

We included 214 patients with at least one available stdEEG study. The first stdEEG was performed after a median time of one (interquartile range (IQR) 0 to 2) day from ICU admission. At the time of recording, 138 (64.5%) patients were under invasive mechanical ventilation. Lateralized periodic discharges were recorded in 91 (42.5%) patients, seizures in 21 (9.8%) and status epilepticus in 16 (7.5%). In the whole population, reactivity to auditory/noxious stimuli was tested in 140/214 (65.4%) patients and was absent in 71/140 (33.2%) cases. In mechanically ventilated patients, stdEEG reactivity was tested in 91/138 (65.9%) subjects, and was absent in 53/91 (58.2%) cases. Absence of reactivity was the only independent stdEEG finding associated with poor functional outcome in the whole population (OR 2.80, 95% CI 1.19 to 6.58) and in the subgroup of mechanically ventilated patients (OR 4.99, 95% CI 1.6 to 15.59). Adjusted analyses for common clinical predictors of outcome and sedation at time of stdEEG revealed similar findings in the whole population (OR 2.03, 95% CI 1.18 to 3.49) and in mechanically ventilated patients (OR 2.62, 95% CI 1.25 to 5.50).

Conclusions

Absence of EEG reactivity to auditory/noxious stimuli is an independent marker of poor functional outcome in severe herpes simplex encephalitis.
Appendix
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Metadata
Title
Electroencephalography for prognostication of outcome in adults with severe herpes simplex encephalitis
Authors
Lina Jeantin
Claire Dupuis
Geoffroy Vellieux
Pierre Jaquet
Etienne de Montmollin
Jean-François Timsit
Romain Sonneville
the ENCEPHALITICA Study Group
Publication date
01-12-2023
Publisher
Springer International Publishing
Published in
Annals of Intensive Care / Issue 1/2023
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-023-01110-3

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