title: Clinical neurophysiological assessment of sepsis-associated brain dysfunction: a systematic review.
abstract: BACKGROUND
  Several studies have reported the presence of electroencephalography (EEG) abnormalities or altered evoked potentials (EPs) during sepsis. However, the role of these tests in the diagnosis and prognostic assessment of sepsis-associated encephalopathy remains unclear.
  
  
  METHODS
  We performed a systematic search for studies evaluating EEG and/or EPs in adult (≥ 18 years) patients with sepsis-associated encephalopathy. The following outcomes were extracted: a) incidence of EEG/EP abnormalities; b) diagnosis of sepsis-associated delirium or encephalopathy with EEG/EP; c) outcome.
  
  
  RESULTS
  Among 1976 citations, 17 articles met the inclusion criteria. The incidence of EEG abnormalities during sepsis ranged from 12% to 100% for background abnormality and 6% to 12% for presence of triphasic waves. Two studies found that epileptiform discharges and electrographic seizures were more common in critically ill patients with than without sepsis. In one study, EEG background abnormalities were related to the presence and the severity of encephalopathy. Background slowing or suppression and the presence of triphasic waves were also associated with higher mortality. A few studies demonstrated that quantitative EEG analysis and EP could show significant differences in patients with sepsis compared to controls but their association with encephalopathy and outcome was not evaluated.
  
  
  CONCLUSIONS
  Abnormalities in EEG and EPs are present in the majority of septic patients. There is some evidence to support EEG use in the detection and prognostication of sepsis-associated encephalopathy, but further clinical investigation is needed to confirm this suggestion.
authors.affiliation: Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium. khosok@gmail.com.
authors.forename: Koji
authors.initials: K
authors.lastname: Hosokawa
authors.affiliation: Comprehensive Epilepsy Center and Computational Neurophysiology Laboratory, Dept. of Neurology, School of Medicine, Yale University, Yale-New Haven Hospital, New Haven, CT, 06520, USA. nicolas.gaspard@erasme.ulb.ac.be.|Department of Neurology, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium. nicolas.gaspard@erasme.ulb.ac.be.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Gaspard
authors.affiliation: Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium. fuhongsu@ulb.ac.be.
authors.forename: Fuhong
authors.initials: F
authors.lastname: Su
authors.affiliation: Department of Intensive Care Medicine, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois), Rue du Bugnon 46, 1011, Lausanne, Switzerland. mauro.oddo@chuv.ch.
authors.forename: Mauro
authors.initials: M
authors.lastname: Oddo
authors.affiliation: Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium. jlvincen@ulb.ac.be.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
authors.affiliation: Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium. ftaccone@ulb.ac.be.
authors.forename: Fabio Silvio
authors.initials: FS
authors.lastname: Taccone
mesh_terms: D001921:Brain / Q000503:physiopathology*; D001927:Brain Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D016638:Critical Illness / Q000453:epidemiology; D004569:Electroencephalography; D005071:Evoked Potentials / Q000502:physiology*; D006801:Humans; D012189:Retrospective Studies; D018805:Sepsis / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*