EEG predictors of outcome in patients with disorders of consciousness admitted for intensive rehabilitation

Abstract

Objective: This study examined the prognostic value of standard EEG in patients with unresponsive wakefulness syndrome (UWS) or in a minimally conscious state (MCS).

Methods: EEGs recorded at admission in 106 patients with UWS or in a MCS were analyzed retrospectively. EEG amplitude, dominant frequency, and reactivity to stimuli were correlated to patient outcomes according to the Coma Recovery Scale Revised (CRS-R). In 101 patients, data were integrated to generate a novel Amplitude-Frequency-Reactivity (AFR) scale, with scores ranging from 3 to 7.

Results: Patients with reduced amplitudes showed less improvement in CRS-R scores at 3 months compared to patients with normal amplitudes. Delta, theta, and alpha frequencies were associated with the least, intermediate, and the greatest improvement in CRS-R scores, respectively. Patients with EEG reactivity showed greater improvements in CRS-R scores than patients without reactivity. The AFR scores for these patients were correlated with outcomes.

Conclusions: Reduced EEG amplitudes and delta frequencies correlated with worse clinical outcomes, while alpha frequencies and reactivity correlated with better outcomes. AFR scores allowed more delineated descriptions of outcomes in patients with normal amplitude, theta frequency, and no reactivity.

Significance: Standard EEG descriptors are related to the 3-month outcomes in patients with disorders of consciousness.

Keywords: EEG amplitude; EEG frequency; EEG reactivity; EEG scale; Minimally conscious state (MCS); Unresponsive wakefulness syndrome (UWS); Vegetative state.