From the Research
Asymmetrical burst suppression in EEG is a concerning finding that requires immediate medical attention and evaluation for underlying neurological issues, as it indicates an abnormal brain state where one hemisphere shows more pronounced burst suppression patterns than the other. This pattern is distinct from the more common symmetrical burst suppression seen in global cerebral dysfunction. The asymmetry provides valuable localizing information for potential underlying pathology and guides further diagnostic and therapeutic approaches.
Key points:
- Urgently consult a neurologist for assessment and management.
- Common causes include focal brain injury, stroke, or localized seizure activity, as suggested by a case report of asymmetric and asynchronous pentobarbital-induced burst suppression after a corpus callosum lesion 1.
- Perform urgent neuroimaging (CT or MRI) to rule out structural abnormalities.
- Consider continuous EEG monitoring to track pattern evolution and detect seizures.
- Treat any underlying causes (e.g., antiepileptic medications for seizures, addressing metabolic disturbances).
- In some cases, induced burst suppression with anesthetic agents like propofol or barbiturates may be used for neuroprotection, but this should be done under close neurological supervision.
The significance of asymmetrical burst suppression is further highlighted by a study on the detection of burst suppression patterns in EEG using recurrence rate, which found that tracking burst suppression patterns is essential for clinical monitoring in critically ill and anesthetized patients 2. Additionally, a neurophysiological-metabolic model for burst suppression suggests that a decrease in cerebral metabolic rate, coupled with the stabilizing properties of ATP-gated potassium channels, leads to the characteristic epochs of suppression 3. However, the most recent and highest quality study on the topic is not directly related to the question, but a 2021 study on awakening from post-anoxic coma with burst suppression with identical bursts highlights the importance of considering the complexity of burst suppression patterns in clinical practice 4.