Quiescence during burst suppression and postictal generalized EEG suppression are distinct patterns of activity

MohammadMehdi Kafashan; L Brian Hickman; Alyssa K Labonte; Emma R Huels; Hannah Maybrier; Christian S Guay; Subha Subramanian; Nuri B Farber; ShiNung Ching; R Edward Hogan; Max B Kelz; Michael S Avidan; George A Mashour; Ben J A Palanca

doi:10.1016/j.clinph.2022.07.493

Quiescence during burst suppression and postictal generalized EEG suppression are distinct patterns of activity

Clin Neurophysiol. 2022 Oct:142:125-132. doi: 10.1016/j.clinph.2022.07.493. Epub 2022 Jul 30.

Authors

Affiliations

¹ Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
² Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA; Department of Neurology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA.
³ Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA; Neuroscience Graduate Program, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
⁴ Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, USA; Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
⁵ Psychological & Brain Sciences Department, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
⁶ Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Picower Institute for Learning & Memory, Massachusetts Institute of Technology, Cambridge, MA, USA.
⁷ Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
⁸ Department of Electrical & Systems Engineering, Washington University in St. Louis, St. Louis, MO, USA; Division of Biology and Biomedical Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
⁹ Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
¹⁰ Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
¹¹ Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA; Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
¹² Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
¹³ Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA; Department of Electrical & Systems Engineering, Washington University in St. Louis, St. Louis, MO, USA; Division of Biology and Biomedical Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA; Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA. Electronic address: [email protected].

Abstract

Objective: Periods of low-amplitude electroencephalographic (EEG) signal (quiescence) are present during both anesthetic-induced burst suppression (BS) and postictal generalized electroencephalographic suppression (PGES). PGES following generalized seizures induced by electroconvulsive therapy (ECT) has been previously linked to antidepressant response. The commonality of quiescence during both BS and PGES motivated trials to recapitulate the antidepressant effects of ECT using high doses of anesthetics. However, there have been no direct electrographic comparisons of these quiescent periods to address whether these are distinct entities.

Methods: We compared periods of EEG quiescence recorded from two human studies: BS induced in 29 healthy adult volunteers by isoflurane general anesthesia and PGES in 11 patients undergoing right unilateral ECT for treatment-resistant depression. An automated algorithm allowed detection of EEG quiescence based on a 10-microvolt amplitude threshold. Spatial, spectral, and temporal analyses compared quiescent epochs during BS and PGES.

Results: The median (interquartile range) voltage for quiescent periods during PGES was greater than during BS (1.81 (0.22) microvolts vs 1.22 (0.33) microvolts, p < 0.001). Relative power was greater for quiescence during PGES than BS for the 1-4 Hz delta band (p < 0.001), at the expense of power in the theta (4-8 Hz, p < 0.001), beta (13-30 Hz, p = 0.04) and gamma (30-70 Hz, p = 0.006) frequency bands. Topographic analyses revealed that amplitude across the scalp was consistently higher for quiescent periods during PGES than BS, whose voltage was within the noise floor.

Conclusions: Quiescent epochs during PGES and BS have distinct patterns of EEG signals across voltage, frequency, and spatial domains.

Significance: Quiescent epochs during PGES and BS, important neurophysiological markers for clinical outcomes, are shown to have distinct voltage and frequency characteristics.

Trial registration: ClinicalTrials.gov NCT04451135.

Keywords: Anesthesia; Burst suppression; Electroconvulsive therapy; Electroencephalography; Major depressive disorder; Postictal generalized electroencephalographic suppression; Seizures.

Publication types

Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

Adult
Algorithms
Electroconvulsive Therapy*
Electroencephalography
Humans
Isoflurane*
Seizures / diagnosis

Quiescence during burst suppression and postictal generalized EEG suppression are distinct patterns of activity

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