Clinical correlates and prognosis in early spindle coma

• Published in: Clinical neurophysiology 2000-04, Vol.111 (4), p.584-590
• Main Authors: Kaplan, Peter W, Genoud, Didier, Ho, Tony W, Jallon, Pierre
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Adolescent; Adult; Aged; Biological and medical sciences; Cardiac arrest; Coma - diagnosis; Coma - etiology; Coma - rehabilitation; Drugs; EEG; Electrodiagnosis. Electric activity recording; Electroencephalography; Etiology; Female; Heart Arrest; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Nervous system; Neurologic Examination; Predictive Value of Tests; Prognosis; Recovery of Function; Retrospective Studies; Spindle coma
• ISSN: 1388-2457; 1872-8952
• DOI: 10.1016/S1388-2457(99)00303-X

Objective: To determine the prognostic significance of spindle coma (SC) according to etiology and EEG reactivity. Methods: We reviewed 15 patients with SC due to various causes within 8 days of coma to determine the prognostic significance of this EEG pattern. Results: The outcome among survivors was favorable: among 13 survivors, 9 were independent in all activities of daily living (ADLs) at 6 months; 3 were dependent in all ADLs; and one remained in coma. EEG reactivity to noxious stimuli best predicted outcome: All patients (whatever the coma etiology) with EEG reactivity survived; conversely, not all patients without EEG reactivity died. Conclusion: In our patients, EEG reactivity independent of etiology predicted survival, neurological examination did not predict outcome. Most SC survivors had a meaningful recovery achieving all ADLs. From the literature, the cause of SC was predictive of outcome: encephalopathy, seizures and trauma had the best prognosis while hypoxia, CRA and structural lesions carried the worst. Literature review revealed that 23% of patients [56/242] died or remained in a persistent vegetative state (PVS). Best outcomes occurred when SC was due to drugs, encephalopathy or seizures: (0/14 died or were in a PVS). With trauma 15% [25/169] died or were in a PVS). Intermediate outcomes occurred with hypoxia and cardio-respiratory arrest (CRA): 33% [7/21] died or were in a PVS. The gravest outcomes occurred with brain-stem and cerebral infarctions, and tumors: 73% [22/30] died or were in a PVS.