TY - JOUR
T1 - Quiescence during burst suppression and postictal generalized EEG suppression are distinct patterns of activity
AU - Kafashan, Mohammad Mehdi
AU - Brian Hickman, L.
AU - Labonte, Alyssa K.
AU - Huels, Emma R.
AU - Maybrier, Hannah
AU - Guay, Christian S.
AU - Subramanian, Subha
AU - Farber, Nuri B.
AU - Ching, Shi Nung
AU - Hogan, R. Edward
AU - Kelz, Max B.
AU - Avidan, Michael S.
AU - Mashour, George A.
AU - Palanca, Ben J.A.
N1 - Publisher Copyright:
© 2022 International Federation of Clinical Neurophysiology
PY - 2022/10
Y1 - 2022/10
N2 - 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.
AB - 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.
KW - Anesthesia
KW - Burst suppression
KW - Electroconvulsive therapy
KW - Electroencephalography
KW - Major depressive disorder
KW - Postictal generalized electroencephalographic suppression
KW - Seizures
UR - http://www.scopus.com/inward/record.url?scp=85136489286&partnerID=8YFLogxK
U2 - 10.1016/j.clinph.2022.07.493
DO - 10.1016/j.clinph.2022.07.493
M3 - Article
C2 - 36030576
AN - SCOPUS:85136489286
SN - 1388-2457
VL - 142
SP - 125
EP - 132
JO - Clinical Neurophysiology
JF - Clinical Neurophysiology
ER -