title: Clinical correlates and prognosis in early spindle coma.
abstract: OBJECTIVE
  To determine the prognostic significance of spindle coma (SC) according to etiology and EEG reactivity.
  
  
  METHODS
  We reviewed 15 patients with SC due to various causes within 8 days of coma to determine the prognostic significance of this EEG pattern.
  
  
  RESULTS
  The outcome among survivors was favorable: among 13 survivors, 9 were independent in all activities of daily living (ADLs) at 6 months; 3 were dependent in all ADLs; and one remained in coma. EEG reactivity to noxious stimuli best predicted outcome: All patients (whatever the coma etiology) with EEG reactivity survived; conversely, not all patients without EEG reactivity died.
  
  
  CONCLUSIONS
  In our patients, EEG reactivity independent of etiology predicted survival, neurological examination did not predict outcome. Most SC survivors had a meaningful recovery achieving all ADLs. From the literature, the cause of SC was predictive of outcome: encephalopathy, seizures and trauma had the best prognosis while hypoxia, CRA and structural lesions carried the worst. Literature review revealed that 23% of patients [56/242] died or remained in a persistent vegetative state (PVS). Best outcomes occurred when SC was due to drugs, encephalopathy or seizures: (0/14 died or were in a PVS). With trauma 15% [25/169] died or were in a PVS). Intermediate outcomes occurred with hypoxia and cardio-respiratory arrest (CRA): 33% [7/21] died or were in a PVS. The gravest outcomes occurred with brain-stem and cerebral infarctions, and tumors: 73% [22/30] died or were in a PVS.
authors.affiliation: Department of Neurology, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, 4940 Eastern Avenue, Baltimore, USA.
authors.forename: P W
authors.initials: PW
authors.lastname: Kaplan
authors.forename: D
authors.initials: D
authors.lastname: Genoud
authors.forename: T W
authors.initials: TW
authors.lastname: Ho
authors.forename: P
authors.initials: P
authors.lastname: Jallon
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D003128:Coma / Q000175:diagnosis* / Q000209:etiology* / Q000534:rehabilitation; D004569:Electroencephalography; D005260:Female; D006323:Heart Arrest; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011237:Predictive Value of Tests; D011379:Prognosis; D020127:Recovery of Function; D012189:Retrospective Studies