Quiescence during burst suppression and postictal generalized EEG suppression are distinct patterns of activity

•We compared quiescent epochs in human EEG acquired during anesthetic BS and PGES following ECT-induced generalized seizures.•Quiescent periods during PGES showed greater amplitude than during BS with stronger relative delta power across the scalp.•Quantitative analyses reveal distinct profiles for...

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Published in:Clinical neurophysiology 2022-10, Vol.142, p.125-132
Main Authors: Kafashan, MohammadMehdi, Brian Hickman, L., Labonte, Alyssa K., Huels, Emma R., Maybrier, Hannah, Guay, Christian S., Subramanian, Subha, Farber, Nuri B., Ching, ShiNung, Hogan, R. Edward, Kelz, Max B., Avidan, Michael S., Mashour, George A., Palanca, Ben J.A.
Format: Article
Language:English
Subjects:
Adult
Algorithms
Anesthesia
Burst suppression
Electroconvulsive Therapy
Electroencephalography
Humans
Isoflurane
Major depressive disorder
Postictal generalized electroencephalographic suppression
Seizures
Seizures - diagnosis
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Summary:•We compared quiescent epochs in human EEG acquired during anesthetic BS and PGES following ECT-induced generalized seizures.•Quiescent periods during PGES showed greater amplitude than during BS with stronger relative delta power across the scalp.•Quantitative analyses reveal distinct profiles for PGES and BS quiescent periods across voltage, frequency, and spatial domains. 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. 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. 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 
ISSN:1388-2457
1872-8952
DOI:10.1016/j.clinph.2022.07.493