From the Research
Burst suppression is not considered true seizures. Burst suppression is an electroencephalographic (EEG) pattern characterized by alternating periods of high-amplitude electrical activity (bursts) and periods of electrical silence or minimal activity (suppression) 1. While this pattern can occur in certain pathological conditions such as severe brain injury, hypothermia, or deep anesthesia, it represents a state of profound brain dysfunction rather than seizure activity. True seizures involve abnormal, excessive, or synchronous neuronal activity in the brain that causes clinical manifestations like convulsions, altered awareness, or sensory disturbances.
The distinction between burst suppression and true seizures is important clinically because the management approaches differ significantly. Burst suppression often indicates a very deep level of brain suppression and may be intentionally induced during certain medical procedures or treatments like barbiturate coma for refractory status epilepticus, whereas seizures require specific antiepileptic medications targeted at normalizing neuronal firing patterns. Understanding this difference helps clinicians properly interpret EEG findings and implement appropriate treatment strategies. Some studies have investigated the relationship between burst suppression and seizures, including a 2023 study that found quantitative assessment of burst suppression can predict seizure recurrence in patients with refractory status epilepticus 1.
Key characteristics of burst suppression include:
- Alternating periods of high-amplitude electrical activity (bursts) and periods of electrical silence or minimal activity (suppression)
- Can occur in certain pathological conditions such as severe brain injury, hypothermia, or deep anesthesia
- Represents a state of profound brain dysfunction rather than seizure activity
- May be intentionally induced during certain medical procedures or treatments
- Differs from true seizures in terms of clinical manifestations and management approaches.
In contrast, true seizures involve abnormal, excessive, or synchronous neuronal activity in the brain that causes clinical manifestations like convulsions, altered awareness, or sensory disturbances. The 2019 study published in Brain: a journal of neurology found that burst suppression can uncover rapid widespread alterations in network excitability caused by an acute seizure focus 2. However, this does not mean that burst suppression is equivalent to true seizures.
Overall, burst suppression should not be considered true seizures, and clinicians should be aware of the differences between these two conditions to provide appropriate treatment and management.