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. 2023 Feb 23;13(1):10.
doi: 10.1186/s13613-023-01110-3.

Electroencephalography for prognostication of outcome in adults with severe herpes simplex encephalitis

Lina Jeantin  1 , Claire Dupuis  2 , Geoffroy Vellieux  3   4 , Pierre Jaquet  5 , Etienne de Montmollin  6   7 , Jean-François Timsit  6   7 , Romain Sonneville  8   9 ; ENCEPHALITICA Study Group
Collaborators, Affiliations

Electroencephalography for prognostication of outcome in adults with severe herpes simplex encephalitis

Lina Jeantin et al. Ann Intensive Care. .

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.

Keywords: Critical care outcomes; Electroencephalography; Encephalitis; Functional status; Herpes simplex; Prognosis.

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Conflict of interest statement

The authors declare they have no competing interests.

Figures

Fig. 1
Fig. 1
Heat map of correlation coefficient values between EEG variables. The correlation coefficients are represented on a colored scale from − 1.0 to 1.0. Discontinuity: discontinuous background rhythm; LPDs: Lateralized periodic discharges
Fig. 2
Fig. 2
Association of EEG reactivity on the first and second stdEEGs with outcome. If more than one stdEEG study was available, we collected data from the first and second studies. We classified patients as “preserved reactivity” when both stdEEG were reactive to external stimuli, “absent reactivity” when none of the two stdEEG was reactive, and “variable reactivity” in patients with discordant reactivity between stdEEG studies (presence of reactivity followed by absence of reactivity, or vice versa). A poor outcome was defined by a score of 3–6 on the modified Rankin scale
See this image and copyright information in PMC

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