“All improving patients had preserved brainstem reflexes, cortical somatosensory-evoked potentials, and reactive EEG background during PSE,” Dr. Rossetti and colleagues reported in the February 24 issue of Neurology.
Three of the group had myoclonic PSE, while the other three had nonconvulsive PSE.
The three patients followed prospectively all had nonconvulsive PSE with preserved brainstem reflexes. All three awoke. These three patients were treated aggressively—as if they had status epilepticus—with benzodiazepines, various antiepileptic drugs, and propofol.
Of the six patients in the group, one subject died of pneumonia in a minimally conscious state. The other five survived to hospital discharge—one patient recovered completely, three had moderate impairment, and one remained dependent. Patients with nonconvulsive PSE showed a better prognosis than subjects with myoclonic PSE.
The investigators observed that “subjects improving beyond the vegetative state share a distinct profile, which includes preserved brainstem reflexes, preserved cortical somatosensory-evoked potentials, and EEG background reactivity. This profile thus appears to be strongly associated with neurologic recovery and seems to occur only in a minority of patients with PSE.”
Dr. Rossetti’s team concluded, “Pending larger multicenter studies, our preliminary data support an early and aggressive management strategy of selected patients with PSE and the described clinical profile, including (when necessary) anesthetic EEG suppression.”
Neurology. 2009;72(8):744-749.