Prognostic value of post-acute EEG in severe disorders of consciousness, using American Clinical Neurophysiology Society terminology

Neurophysiol Clin. 2019 Sep;49(4):317-327. doi: 10.1016/j.neucli.2019.07.001. Epub 2019 Jul 18.


Objective: To evaluate whether electroencephalographic (EEG) features recorded during the post-acute stage in patients with severe disorders of consciousness (DoC) after acute brain injury (ABI), contribute to neurological outcome prediction of these patients at discharge from the intensive rehabilitation unit (IRU).

Methods: We retrospectively evaluated all patients consecutively admitted to the IRU from August 2012 to December 2016. Inclusion criteria were: 1) age >18years, 2) patients with unresponsive wakefulness syndrome (UWS) or in a minimally conscious state (MCS), and 3) EEG and a coma recovery scale-revised (CRS-R) score available within the first week after admission. Clinical evaluation was performed using the Italian version of the CRS-R score. EEGs were classified according to American Clinical Neurophysiology Society (ACNS) terminology. Clinical state at final discharge was evaluated using the CRS-R score.

Results: In total, 102 patients were included in the analysis. After a mean of five months of IRU stay, among the 61 UWS subjects, 19 transitioned to MCS and 11 recovered to exit-MCS (E-MCS); twenty-three of the 41 subjects in MCS progressed to E-MCS. Using logistic regression, consciousness level (UWS/MCS-OR=13.4), CRS-R score at admission (OR=1.33) and use of activating drugs (OR=4.7) were significant predictors of clinical improvement. Multivariable analysis showed that specific EEG patterns were independent predictors of improved consciousness at discharge in UWS patients.

Discussion: EEG performed within the first week after IRU admission, classified according to ACNS-terminology in patients with UWS at admission, can provide useful prognostic contribution.

Keywords: CRS-r; Disorder of consciousness; EEG; MCS; Prognosis.

MeSH terms

  • Brain Injuries / complications
  • Brain Injuries / diagnosis*
  • Brain Injuries / physiopathology*
  • Consciousness Disorders / diagnosis*
  • Consciousness Disorders / etiology
  • Consciousness Disorders / physiopathology*
  • Electroencephalography
  • Female
  • Humans
  • Male
  • Persistent Vegetative State / diagnosis
  • Persistent Vegetative State / etiology
  • Persistent Vegetative State / physiopathology
  • Prognosis
  • Retrospective Studies
  • Societies, Medical
  • Trauma Severity Indices