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The EEG in Metabolic Encephalopathy and Coma

Kaplan, Peter W.

doi: 10.1097/01.WNP.0000145004.22230.D5

Excellent early work on stupor and coma can be found (particularly with regard to anoxia) in the work of Fischgold and Mathis (1959) in France, and Pamela Prior in England (1973a). These workers correlated deepening levels of coma with particular EEG patterns, and the suppression of EEG reactivity. Alpha frequency patterns in coma (alpha coma), spindle-like sleep patterns in coma (spindle coma) and “triphasic waves” are among the wide variety of endocrine disorders discussed in case reports and series leading to identification of particular EEG patterns. EEG correlations with prognosis are most reliable with cardiorespiratory arrest (CRA) with its consequent anoxic-ischemic insult. If etiology is known, EEG can often be a reliable predictor of outcome. EEG usually has little specificity with regards to etiology, but some patterns do favor particular diagnoses: for example, triphasic waves (TWs) are frequently seen with hepatic and renal insufficiency in young adults; spindle coma patterns are believed to indicate dysfunction at the brainstem level (Chatrian, 1990). EEG is most useful in differentiating organic from psychiatric conditions, in excluding nonconvulsive status epilepticus (NCSE), and in providing a rough guide as to the degree of cortical and subcortical dysfunction.

Department of Neurology, Johns Hopkins Bayview Medical Center and Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.

Address correspondence and reprint requests to Dr. Peter W. Kaplan, Department of Neurology, Johns Hopkins Bayview Medical Center, B. Building, 1 North, Room 125, 4940 Eastern Avenue, Baltimore, MD 21224, U.S.A.; e-mail:

Copyright © 2004 American Clinical Neurophysiology Society