Electroencephalography for prognostication of outcome in adults with severe herpes simplex encephalitis
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 retrospec...
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| Format: | Article |
| Language: | English |
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SpringerOpen
2023-02-01
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| Series: | Annals of Intensive Care |
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| Online Access: | https://doi.org/10.1186/s13613-023-01110-3 |
| _version_ | 1797863529893593088 |
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| author | Lina Jeantin Claire Dupuis Geoffroy Vellieux Pierre Jaquet Etienne de Montmollin Jean-François Timsit Romain Sonneville the ENCEPHALITICA Study Group |
| author_facet | Lina Jeantin Claire Dupuis Geoffroy Vellieux Pierre Jaquet Etienne de Montmollin Jean-François Timsit Romain Sonneville the ENCEPHALITICA Study Group |
| author_sort | Lina Jeantin |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-09T22:38:02Z |
| format | Article |
| id | doaj.art-4156c568f854448f9c5d0c027e2a21de |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-04-09T22:38:02Z |
| publishDate | 2023-02-01 |
| publisher | SpringerOpen |
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| series | Annals of Intensive Care |
| spelling | doaj.art-4156c568f854448f9c5d0c027e2a21de2023-03-22T12:22:18ZengSpringerOpenAnnals of Intensive Care2110-58202023-02-0113111010.1186/s13613-023-01110-3Electroencephalography for prognostication of outcome in adults with severe herpes simplex encephalitisLina Jeantin0Claire Dupuis1Geoffroy Vellieux2Pierre Jaquet3Etienne de Montmollin4Jean-François Timsit5Romain Sonneville6the ENCEPHALITICA Study GroupDepartment of Neurology, GHU Paris Psychiatrie et Neurosciences, Université de ParisDepartment of Intensive Care Medicine, Clermont-Ferrand University HospitalParis Brain Institute, ICM, Inserm, CNRS, Sorbonne UniversitéDepartment of Intensive Care Medicine, Delafontaine HospitalIAME, INSERM, UMR1137, Université Paris CitéIAME, INSERM, UMR1137, Université Paris CitéIAME, INSERM, UMR1137, Université Paris CitéAbstract 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.https://doi.org/10.1186/s13613-023-01110-3Herpes simplexEncephalitisElectroencephalographyPrognosisCritical care outcomesFunctional status |
| spellingShingle | Lina Jeantin Claire Dupuis Geoffroy Vellieux Pierre Jaquet Etienne de Montmollin Jean-François Timsit Romain Sonneville the ENCEPHALITICA Study Group Electroencephalography for prognostication of outcome in adults with severe herpes simplex encephalitis Annals of Intensive Care Herpes simplex Encephalitis Electroencephalography Prognosis Critical care outcomes Functional status |
| title | Electroencephalography for prognostication of outcome in adults with severe herpes simplex encephalitis |
| title_full | Electroencephalography for prognostication of outcome in adults with severe herpes simplex encephalitis |
| title_fullStr | Electroencephalography for prognostication of outcome in adults with severe herpes simplex encephalitis |
| title_full_unstemmed | Electroencephalography for prognostication of outcome in adults with severe herpes simplex encephalitis |
| title_short | Electroencephalography for prognostication of outcome in adults with severe herpes simplex encephalitis |
| title_sort | electroencephalography for prognostication of outcome in adults with severe herpes simplex encephalitis |
| topic | Herpes simplex Encephalitis Electroencephalography Prognosis Critical care outcomes Functional status |
| url | https://doi.org/10.1186/s13613-023-01110-3 |
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