Etiology, neurologic correlations, and prognosis in alpha coma

Peter W Kaplan, Didier Genoud, Tony W. Ho, Pierre Jallon

Research output: Contribution to journalArticle

Abstract

Objective: To determine the factors affecting prognosis in alpha coma (AC). Methods: Retrospective review of 36 study patients, 36 control coma patients matched for age and etiology, and meta-analysis of 335 cases in the world literature. Results: Principal causes were cardiorespiratory arrest (CRA) (21 patients); infection, metabolic dysfunction, bead trauma (3 each); and drugs, stroke and hypoxia (2 each). Outcome was predicated by EEG reactivity to noxious stimuli. Fourteen of the 15 patients with reactive EEGs, had measurable outcome, 8 awoke - all but two had etiologies other than CRA. Fourteen of 19 patients without EEG reactivity died; two had support discontinued and 3 awoke. Following CRA, 16/21 patients died and 3 had support discontinued. Only 3 patients made a good recovery - all with toxic or metabolic etiologies. Literature meta-analysis of 335 cases showed that overall, AC carried a poor prognosis (76% died). CRA (226 Cases) had an 88% mortality; strokes (29 Cases), a 90% mortality; bypoxia without cardiac arrest (28 cases), a 61% mortality; drug-induced AC (25 cases), an 8% mortality. Conclusions: Although the cause of AC largely predicts outcome, EEG reactivity in AC predicted survival: most patients with reactivity awoke; most of those without, died. Few survivors bad meaningful recovery.

Original languageEnglish (US)
Pages (from-to)205-213
Number of pages9
JournalClinical Neurophysiology
Volume110
Issue number2
DOIs
Publication statusPublished - Feb 1 1999

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Keywords

  • Alpha coma
  • EEG
  • Etiology
  • Prognosis

ASJC Scopus subject areas

  • Clinical Neurology
  • Radiology Nuclear Medicine and imaging
  • Neurology
  • Sensory Systems
  • Physiology (medical)

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