TY - JOUR
T1 - Electroencephalography for diagnosis and prognosis of acute encephalitis
AU - Sutter, Raoul
AU - Kaplan, Peter W.
AU - Cervenka, Mackenzie C.
AU - Thakur, Kiran T.
AU - Asemota, Anthony O.
AU - Venkatesan, Arun
AU - Geocadin, Romergryko G.
N1 - Funding Information:
No funding was received for this study. This study was performed and designed without the input or support of any pharmaceutical company, or other commercial interest. Dr. R. Sutter was supported by the Research Fund of the University of Basel, the Scientific Society Basel, and the Gottfried Julia Bangerter-Rhyner Foundation. Dr. M. Cervenka received funding from the Johns Hopkins University School of Medicine Clinician Scientist Award, Nutricia, and NIH (NINDS R01NS075020).
Publisher Copyright:
© 2014 International Federation of Clinical Neurophysiology.
PY - 2015/8/1
Y1 - 2015/8/1
N2 - Objectives: To confirm the previously identified EEG characteristics for HSV encephalitis and to determine the diagnostic and predictive value of electroencephalography (EEG) features for etiology and outcome of acute encephalitis in adults. In addition, we sought to investigate their independence from possible clinical confounders. Methods: This study was performed in the Intensive Care Units of two academic tertiary care centers. From 1997 to 2011, all consecutive patients with acute encephalitis who received one or more EEGs were included. Examination of the diagnostic and predictive value of EEG patterns regarding etiology, clinical conditions, and survival was performed. The main outcome measure was in-hospital death. Results: Of 103 patients with encephalitis, EEGs were performed in 76 within a median of 1 day (inter quartile range 0.5-3) after admission. Mortality was 19.7% Higher proportions of periodic discharges (PDs) (p= 0.029) and focal slowing (p= 0.017) were detected in Herpes Simplex virus (HSV) encephalitis as compared to non-HSV encephalitis, while clinical characteristics did not differ. Normal EEG remained the strongest association with a low relative risk for death in multivariable analyses (RR < 0.001, p< 0.001) adjusting for confounders as coma, global cerebral edema and mechanical ventilation. None of the patients with a normal EEG had a GCS of 15 Conclusions: Normal EEG predicted survival independently from possible confounders, highlighting the prognostic value of EEG in evaluating patients with encephalitis. EEG revealed higher proportions of PDs along with focal slowing in HSV encephalitis as compared to other etiologies. Significance: EEG significantly adds to clinical, diagnostic and prognostic information in patients with acute encephalitis.
AB - Objectives: To confirm the previously identified EEG characteristics for HSV encephalitis and to determine the diagnostic and predictive value of electroencephalography (EEG) features for etiology and outcome of acute encephalitis in adults. In addition, we sought to investigate their independence from possible clinical confounders. Methods: This study was performed in the Intensive Care Units of two academic tertiary care centers. From 1997 to 2011, all consecutive patients with acute encephalitis who received one or more EEGs were included. Examination of the diagnostic and predictive value of EEG patterns regarding etiology, clinical conditions, and survival was performed. The main outcome measure was in-hospital death. Results: Of 103 patients with encephalitis, EEGs were performed in 76 within a median of 1 day (inter quartile range 0.5-3) after admission. Mortality was 19.7% Higher proportions of periodic discharges (PDs) (p= 0.029) and focal slowing (p= 0.017) were detected in Herpes Simplex virus (HSV) encephalitis as compared to non-HSV encephalitis, while clinical characteristics did not differ. Normal EEG remained the strongest association with a low relative risk for death in multivariable analyses (RR < 0.001, p< 0.001) adjusting for confounders as coma, global cerebral edema and mechanical ventilation. None of the patients with a normal EEG had a GCS of 15 Conclusions: Normal EEG predicted survival independently from possible confounders, highlighting the prognostic value of EEG in evaluating patients with encephalitis. EEG revealed higher proportions of PDs along with focal slowing in HSV encephalitis as compared to other etiologies. Significance: EEG significantly adds to clinical, diagnostic and prognostic information in patients with acute encephalitis.
KW - EEG patterns
KW - Electroencephalography
KW - Encephalitis
KW - Neurocritical care
UR - http://www.scopus.com/inward/record.url?scp=84937675078&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84937675078&partnerID=8YFLogxK
U2 - 10.1016/j.clinph.2014.11.006
DO - 10.1016/j.clinph.2014.11.006
M3 - Article
C2 - 25476700
AN - SCOPUS:84937675078
SN - 1388-2457
VL - 126
SP - 1524
EP - 1531
JO - Clinical Neurophysiology
JF - Clinical Neurophysiology
IS - 8
ER -