Electroencephalographic arousal pattern in severe alcohol poisoning

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Abstract

Parameters dynamics of brain bioelectric activity of 50 patients in alcoholic coma are  considered. Patients underwent continuous EEG monitoring from the end of the basic resuscitation to the apparent recovery of consciousness (awakening). The average registration time was 4.5 hours. EEG was recorded in standard derivations using the 10–20 system. The amplitude-frequency indices of spontaneous activity and reactivity are analyzed. Electroencephalographic correlates of cerebral insufficiency in comatose states are distinguished by pronounced polymorphism and high individual variability. Considering these features, “dynamic” parameters should be used as prognostic criteria: spontaneity and variability of the pattern, reactivity during stimulation. The increase in the frequency of bioelectric activity, desynchronization with external stimuli may indicate the beginning of the process of recovery of consciousness. Electrophysiological criteria for awakening, developed in this work on the example of alcoholic coma, can be mostly applicable to unconscious states caused by other etiological factors: trauma, hypoxia, vascular failure.

About the authors

Mikhail V. Aleksandrov

Russian Neurosurgery Research Institute named after prof. A.L. Polenov (branch of the Almazov National Medical Research Center); Institute of toxicology of Federal Medical-Biological Agency

Email: mdoktor@yandex.ru
Russian Federation, St.Petersburg

Ekaterina S. Povalyukhina

Russian Neurosurgery Research Institute named after prof. A.L. Polenov (branch of the Almazov National Medical Research Center); Dzhanelidze Research Institute of Emergency Medicine

Email: mdoktor@yandex.ru
Russian Federation, St.Petersburg

Tatyana V. Alexandrova

Dzhanelidze Research Institute of Emergency Medicine

Email: tata-al@yandex.ru
Russian Federation, St.Petersburg

Lev B. Ivanov

Moscow City Clinical Hospital № 9 of G.N. Speransky

Email: mdoktor@yandex.ru
Russian Federation, Moscow

Valery S. Chernyi

Military Medical Academy named after S.M. Kirov

Author for correspondence.
Email: 9297911@list.ru
Russian Federation, St.Petersburg

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2. Fig. 2. A typical example of an EEG delta-coma pattern: diffuse delta activity with a frequency of 2–3 Hz and amplitude up to 50 µV, resistant to external stimulation (patient R., 42 years old, acute severe ethanol poisoning; the concentration of ethanol in the blood is 5.6‰, in the urine — 7.5‰; coma-2, level of consciousness — 5 points GCS)

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3. Fig. 3. The variation of awakening EEG pattern: rhythmicized alpha activity, unstable in frequency (9–10–11 Hz) with an amplitude of 30–50 µV, with a tendency to diffuse propagation (decrease in front-occipital gradient), alpha activity is not blocked when opening the eyes (passive opening of the eyes corresponds to a fragment with artifacts of the movement of the eyeballs in the frontal leads)

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4. Fig. 4. Awakening pattern formation time on the EEG of the patients with severe ethanol poisoning with different levels of bioelectric activity inhibition: coma-1.0 — theta-coma pattern, coma-2.0 — delta coma pattern. Box height limits interquartile range (IQR) between first and third quartiles; line in the box — median; intervals limit the values ± 1.5 IQR

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5. Fig. 5. The dynamics of bioelectric activity and pattern reactivity in the patients with acute severe ethanol poisoning. The straight line in the diagram indicates the “theta-coma” pattern, the dotted one — “delta coma”. With pain stimulation (arrow), a distinct desynchronization of background activity is recorded

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Copyright (c) 2019 Aleksandrov M.V., Povalyukhina E.S., Alexandrova T.V., Ivanov L.B., Chernyi V.S.

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This work is licensed under a Creative Commons Attribution 4.0 International License.

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