Brain networks involved in generalized periodic discharges (GPD) in post-anoxic-ischemic encephalopathy. (October 2020)

• Record Type: Journal Article
• Authors: De Stefano, Pia; Carboni, Margherita; Pugin, Deborah; Seeck, Margitta; Vulliémoz, Serge
• Is Part Of: Resuscitation. Volume 155(2020)
• Page Start: 143
• Page End: 151
• Publication Date: 2020-10
• Subjects: CA cardiac arrest -- GPD generalized periodic discharge -- NCSE non convulsive status epilepticus -- ESI Electrical Source Imaging -- iPDC Information Partial Directed Coherence -- LSMAC Locally Spherical Model with Anatomical Constraints -- LAURA Local AUtoRegressive Average -- ROI region of interest -- ROIs regions of interest; Generalized periodic discharges -- GPD -- Non-convulsive status epilepticus -- Anoxic-ischemic encephalopathy -- Cardiac arrest; Resuscitation -- Periodicals; Resuscitation -- Periodicals; Réanimation -- Périodiques; Electronic journals; 616.025
• DOI: 10.1016/j.resuscitation.2020.07.030
• Languages: English
• ISSNs: 0300-9572

Abstract

Abstract: Aim: Generalized periodic discharge (GPD) is an EEG pattern of poor neurological outcome, frequently observed in comatose patients after cardiac arrest. The aim of our study was to identify the neuronal network generating ≤2.5 Hz GPD using EEG source localization and connectivity analysis. Methods: We analyzed 40 comatose adult patients with anoxic-ischemic encephalopathy, who had 19 channel-EEG recording. We computed electric source analysis based on distributed inverse solution (LAURA) and we estimated cortical activity in 82 atlas-based cortical brain regions. We applied directed connectivity analysis (Partial Directed Coherence) on these sources to estimate the main drivers. Results: Source analysis suggested that the GPD are generated in the cortex of the limbic system in the majority of patients (87.5%). Connectivity analysis revealed main drivers located in thalamus and hippocampus for the large majority of patients (80%), together with important activation also in amygdala (70%). Conclusions: We hypothesize that the anoxic-ischemic dysfunction, leading to hyperactivity of the thalamo-cortical (limbic presumably) circuit, can result in an oscillatory thalamic activity capable of inducing periodic cortical (limbic, mostly medial-temporal and orbitofrontal) discharges, similarly to the case of generalized rhythmic spike-wave discharge in convulsive or non-convulsive status epilepticus.