Optimum parameters of EEG burst suppression in the management of refractory status epilepticus

Burst suppression is a pattern of brain activity that can be observed on an electroencephalogram (EEG) and is characterized by alternating periods of high-amplitude electrical bursts and periods of suppression where there is little to no electrical activity. Refractory status epilepticus is defined as status epilepticus that does not respond to initial and second-line anticonvulsant medications (e.g., benzodiazepines, phenytoin, levetiracetam, valproate) and may require more aggressive interventions. RSE typically requires the use of anesthetic agents to induce burst suppression and control the seizures in the ICU under close monitoring. The use of burst suppression in RSE is a complex decision, balancing the need to stop seizures with the risks of further neurological impairment. Though burst suppression is widely used in RSE, the optimum parameters of burst suppression needed to terminate RSE have not been clearly defined. At Monash Medical Centre, we have been using burst suppression to treat RSE for over 10 years. This study is aimed at finding the optimum parameters of burst suppression to achieve the best outcomes from a large database of EEGs. The study involves qualitative and quantitative analysis of EEG signals and correlating with patient outcomes.