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Critical Care
Published in: Critical Care 1/2018

Open Access 01-12-2018 | Research

Value and mechanisms of EEG reactivity in the prognosis of patients with impaired consciousness: a systematic review

Authors: Eric Azabou, Vincent Navarro, Nathalie Kubis, Martine Gavaret, Nicholas Heming, Alain Cariou, Djillali Annane, Fréderic Lofaso, Lionel Naccache, Tarek Sharshar

Published in: Critical Care | Issue 1/2018

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Abstract

Background

Electroencephalography (EEG) is a well-established tool for assessing brain function that is available at the bedside in the intensive care unit (ICU). This review aims to discuss the relevance of electroencephalographic reactivity (EEG-R) in patients with impaired consciousness and to describe the neurophysiological mechanisms involved.

Methods

We conducted a systematic search of the term “EEG reactivity and coma” using the PubMed database. The search encompassed articles published from inception to March 2018 and produced 202 articles, of which 42 were deemed relevant, assessing the importance of EEG-R in relationship to outcomes in patients with impaired consciousness, and were therefore included in this review.

Results

Although definitions, characteristics and methods used to assess EEG-R are heterogeneous, several studies underline that a lack of EEG-R is associated with mortality and unfavorable outcome in patients with impaired consciousness. However, preserved EEG-R is linked to better odds of survival. Exploring EEG-R to nociceptive, auditory, and visual stimuli enables a noninvasive trimodal functional assessment of peripheral and central sensory ascending pathways that project to the brainstem, the thalamus and the cerebral cortex. A lack of EEG-R in patients with impaired consciousness may result from altered modulation of thalamocortical loop activity by afferent sensory input due to neural impairment. Assessing EEG-R is a valuable tool for the diagnosis and outcome prediction of severe brain dysfunction in critically ill patients.

Conclusions

This review emphasizes that whatever the etiology, patients with impaired consciousness featuring a reactive electroencephalogram are more likely to have a favorable outcome, whereas those with a nonreactive electroencephalogram are prone to having an unfavorable outcome. EEG-R is therefore a valuable prognostic parameter and warrants a rigorous assessment. However, current assessment methods are heterogeneous, and no consensus exists. Standardization of stimulation and interpretation methods is needed.
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Metadata
Title
Value and mechanisms of EEG reactivity in the prognosis of patients with impaired consciousness: a systematic review
Authors
Eric Azabou
Vincent Navarro
Nathalie Kubis
Martine Gavaret
Nicholas Heming
Alain Cariou
Djillali Annane
Fréderic Lofaso
Lionel Naccache
Tarek Sharshar
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2018
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-018-2104-z

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