Andrea O Rossetti’s research while affiliated with University of Lausanne and other places

Status epilepticus (SE) is a neurological emergency with significant morbidity and mortality. The role of sex as a factor influencing the characteristics, treatment, and outcomes of SE has been scarcely addressed. This study investigates this variable regarding the clinical management and outcome among adult patients with SE. We retrospectively analyzed the Centre Hospitalier Universitaire Vaudois (CHUV) Status Epilepticus Registry (SERCH) over a 10‐year period, including 961 SE episodes in 831 patients (56.82% male; 43.18% female), excluding post‐axonic cases. There were no statistically significant differences in age, potentially fatal etiology, or pre‐treatment consciousness impairment between sexes. Male patients were slightly younger (mean age 61 vs 64 years, p =.03), had a higher prevalence of prior seizures (54.76% vs 47.9%, p = .04), and were more likely to present with generalized convulsive SE (51.5% vs 41%), whereas female patients exhibited a higher frequency of focal unaware SE (31.7% vs 22.1%, global p = .02). Treatment strategies were similar across sexes, with benzodiazepines as first‐line therapy in over 80% of cases, levetiracetam being the most frequently prescribed second‐line treatment, followed by valproate and lacosamide. Development of refractory SE was comparable between sexes (54% in both, p = .92); outcomes at discharge were also similar. SE refractoriness and return to baseline conditions remained similar after multivariable adjustment for potential confounders. Overall, our results suggest comparable SE management, treatment responsiveness and outcomes between men and women.

We assessed outcome prediction of comatose patients using a deep learning analysis applied to resting EEG on the first and second day after cardiac arrest (CA), and its added value to clinical prognosis. We recorded 62-channel resting-state EEG in comatose patients after CA across three Swiss hospitals during the first (N=165) and second (N=100) coma day. Patient outcome was classified as favorable if the best Cerebral Performance Category was 1-2. A convolutional neural network provided a predicted probability for favorable outcome for each patient’s and recording day’s 62-channel and 19-channel EEG. Predictive performance was additionally evaluated on an external 19-channel dataset collected outside Switzerland (N=60). The deep learning prediction was compared to EEG-based clinical markers - according to the American Clinical Neurophysiology Society -, brainstem reflexes and motor responses. On the first day, patient outcome was predicted with an accuracy of 0.94±0.03 for 62 channels and 0.90±0.03 and 0.87 for 19 channels using the Swiss and external dataset, respectively. High outcome prediction (0.98 accuracy) was observed when considering only patients with uncertain prognosis based on clinical assessment. The second day was less predictive, with an accuracy of 0.72±0.05. The estimated outcome prediction correlated with spectral power on the first day for favorable (r =0.38, p=0.01) and unfavorable (r=-0.28, p=0.02) outcome patients, and was consistent with clinical markers (p<0.0001), except brainstem reflexes. On the first day of coma in CA patients, a deep learning analysis of resting-state high-density EEG provides accurate outcome prediction, superior to lower-density EEG, and complements clinical markers. Graphical abstract

A key question for the scientific study of consciousness is whether it is possible to identify specific features in brain activity that are uniquely linked to conscious experience. This question has important implications for the development of markers to detect covert consciousness in unresponsive patients. In this regard, many studies have focused on investigating the neural response to complex auditory regularities. One noteworthy example is the local global paradigm, which allows for the investigation of auditory regularity encoding at the ‘global’ level, based on the repetition of groups of sounds. The inference of global regularities is thought to depend on conscious access to such complex auditory stimuli as mostly shown in chronic stages of disorders of consciousness patients. However, whether global regularity encoding can identify covert consciousness along the consciousness spectrum including earlier stages of these disorders remains controversial. Here, we aim to fill this gap by investigating whether the inference of global auditory regularities can occur in acute coma, in the absence of consciousness, and how this may be modulated by the severity of the patients’ clinical condition and consciousness level measured using the Full Outline of UnResponsiveness (FOUR) score. We will acquire 63-channel continuous electroencephalography to measure the neural response to global auditory regularity in comatose patients (N = 30) during the first day after cardiac arrest, when patients are unconscious, sedated and under normothermia, and during the second day (with reduced or absent sedation and body temperature control). We hypothesize that global regularity encoding will persist in the absence of consciousness independent of patient outcome, observed as above chance decoding of the neural response to global regularities using multivariate decoding analyses. We further hypothesize that decoding performance will positively correlate with the FOUR score, which indexes consciousness level, and typically improves between the first and second day after coma onset following cardiac arrest in patients with favourable outcome. In an exploratory analysis, we will also evaluate whether global regularity encoding may be influenced by the patients’ clinical management, specifically sedation, also shown to affect global deviance detection. Our results will shed light on the neurophysiological correlates of complex auditory regularity processing in unconscious patients and on the link to residual levels of consciousness during the underexplored state of coma upon the first days after cardiac arrest.

Background Outcome prediction in Status epilepticus (SE) aids in clinical decision‐making, yet existing scores have limitations due to SE heterogeneity. Serum albumin is emerging as a readily available prognostic biomarker in various clinical conditions. This study evaluates hypoalbuminemia in predicting short‐ and long‐term mortality. Methods Observational cohort study including non‐hypoxic SE adult patients admitted to the University Hospital of Geneva (Switzerland) between 2015 and 2023. Primary outcomes were in‐hospital and 6‐month mortality. Results Four hundred and ninety‐six patients were included, 46 (9.3%) died in hospital; 6‐month outcome was available for 364 patients, 86 (23.6%) were not alive at follow‐up. Hypoalbuminemia was associated with older age and patients' comorbidities. Binomial regression showed an independent correlation between hypoalbuminemia and short‐ (p = 0.005, OR = 3.35, 95% CI = 1.43–7.86) and long‐term mortality (p = 0.001, OR = 3.59,95% CI = 1.75–7.35). The Status Epilepticus Severity Score (STESS) had an overall AUC of 0.754 (95% CI = 0.656–0.836) for predicting in‐hospital mortality and of 0.684 (95% CI = 0.613–0.755) for 6‐month mortality. Through an exploratory analysis, we replaced age with hypoalbuminemia in the STESS, creating the Albumin‐STESS (A‐STESS) score (0–6). The global A‐STESS AUC significantly improved for both in‐hospital (0.837, 95% CI = 0.760–0.916, p = 0.002) and 6‐month (0.739, 95% CI = 0.688–0.826; p = 0.033) mortality prediction. A‐STESS‐3 cutoff demonstrated a strong sensitivity‐specificity balance for both in‐hospital (sensitivity = 0.88, specificity = 0.68, accuracy = 0.70) and 6‐month (sensitivity = 0.67, specificity = 0.73, accuracy = 0.72) mortality. Conclusions Hypoalbuminemia is an easily measurable biomarker reflecting the overall patient's condition and is independently related to short‐ and long‐term SE mortality. Integrating hypoalbuminemia into the STESS (A‐STESS) significantly enhances mortality prediction. Future studies are needed to externally validate the A‐STESS and evaluate the benefits of albumin supplementation in SE patient prognosis.

General anesthesia (GA) earlier than recommended (as first‐ or second‐line treatment) was recently described to improve status epilepticus (SE) outcome. We aimed to assess the impact of early GA on outcome in matched groups. Data from a multicenter, prospective cohort of 1179 SE episodes in 1049 adults were retrospectively analyzed. Incident SE episodes were categorized as “early anesthesia” (eGA; GA as first‐ or second‐line treatment) or “non‐early anesthesia” (neGA; GA after second‐line treatment or not at all). Using propensity score matching, eGA episodes were paired 1:4 with neGA episodes. We assessed survival, functional outcomes at discharge (good: modified Rankin Scale = 0–2 or no worsening), SE cessation rate, SE duration, and hospital stay. Among 1049 SE episodes, 55 (5.2%) received eGA, and 994 constituted the neGA group; 220 represented the matched controls. Patients receiving eGA were younger (median = 63, interquartile range [IQR] = 56–76 vs. median = 70, IQR = 54–80 years, p = .004), had deeper consciousness impairment (80% vs. 40% stuporous/comatose, p < .001), and had more severe SE forms (89% vs. 54% generalized convulsive SE/nonconvulsive SE in coma, p < .001). Mortality, functional outcome, SE cessation rate, and duration of SE and hospital stay were similar between the eGA group and matched controls. We conclude that early anesthesia for SE treatment did not influence prognosis.

This Viewpoint challenges conventional clinical practice that eschews pharmacological intervention for comatose patients with epileptiform abnormalities after cardiac arrest using evidence from the Treatment of Electroencephalographic Status Epilepticus after Cardiopulmonary Resuscitation (TELSTAR) trial.

Introduction: In a cohort of adult patients with disturbance of consciousness after TBI, we aimed to explore the relationship of continuous video-EEG (cEEG) and routine EEG (rEEG) with mortality and functional outcome. Methods: Post-hoc analysis of data from a randomized controlled trial (CERTA study), in which adults with disorder of consciousness and needing EEG were randomized 1:1 to cEEG or two rEEG. In TBI patients, correlation between EEG duration and mortality and modified Rankin score (mRs, good 0-2) at 6 months was assessed. Results: Among 364 patients, 44 patients presenting with consciousness impairment after TBI were included; 29 randomized to cEEG and 15 to rEEG. Mortality (p=0.88) and functional outcome (p=0.58) at 6 months were similar between groups. There was a nonsignificant tendency toward more seizure/status epilepticus detection with cEEG (p=0.08). In multivariable regression, cEEG was not related to functional outcome (OR 0.75 [0.13-4.24], p=0.745) or mortality (OR 7.11 [0.51-99.32], p=0.145). Conclusion: Despite allowing increased seizure detections in TBI patients, cEEG does not seem to be not associated with better functional clinical outcome or mortality over rEEG. Pending larger trials, repeated rEEG might be acceptable in post TBI disorder of consciousness, especially in resource-limited environments.