Abstract Details

Title Quantitative oculography in conscious sleep study and comatose subjects

Topic Neuro Trauma, Critical Care, and Sports Neurology

Presentation(s) Neurocritical Care Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 025

Objective To evaluate quantified eye movement frequency using electrooculography (EOG) in comatose cardiac arrest patients compared to sleep study controls.

Background In patients with intact cortical and brainstem structures, eyes move in both aroused and unaroused states via visual pursuit and REM sleep. Increased eye movements can distinguish between patients who attain at least a minimally conscious state in a subacute setting after brain injury. However, little is known about the association of quantified eye movements and arousal recovery in the acute setting after cardiac arrest, and how it compares to healthy sleep.

Design/Methods Eye movement frequency (EMF) was collected from 1-hour samples of 25 sleep study patients aged 18-90 not on REM suppressing medications (median age 50, 9 sleep stage N1/N2, 8 sleep stage REM, 8 sleep stage N3). Each 1-second epoch was hand-labeled for eye movement, direction (left/up v. right/down) and duration (fast v. slow). We compared eye movement frequency from sleep study patients to EOGs from 7 comatose cardiac arrest patients (median age 55) within 24-72 hours after arrest, all but two with targeted temperature management.

Results EMF was higher during REM and drowsiness/N1/N2, (7.6% and 10.5% respectively) compared to N3 (4%). Both were higher than eye movement frequency (0.05%) in cardiac arrest patients. Pupillary light reflexes (PLR) did not correlate with increased EMF. Patients with PLRs had a median EMF of 8.5 (0.005%) in contrast to patients without PLRs, 19 (0.01%). All seven patients expired during the hospitalization with six being due to the withdrawal of life-sustaining treatment and one secondary to cerebral edema while still ventilated.

Conclusions Regardless of sleep stage, sleep study patients have a higher frequency of eye movements compared to comatose cardiac arrest patients. This preliminary evidence suggests that quantified eye movement frequency may assist in determining recovery of consciousness in comatose patients.

Authors/Disclosures
Alicia E. Dupre, MD (Oregon Health and Science University) PRESENTER	Dr. Dupre has nothing to disclose.
Alicia E. Dupre, MD (Oregon Health and Science University)	Dr. Dupre has nothing to disclose.
	No disclosure on file
Min Shin (UNC Charlotte)	No disclosure on file
Samuel Tate (University of North Carolina at Charlotte)	No disclosure on file
Anna Marisa Cervantes-Arslanian, MD, FAAN (BU Dept of Neurology)	Dr. Cervantes-Arslanian has nothing to disclose.
Myriam Abdennadher, MD (Boston University School of Medicine/Boston Medical Center)	The institution of Dr. Abdennadher has received research support from Grinspoon Foundation. The institution of Dr. Abdennadher has received research support from Boston University CTSI grant. The institution of Dr. Abdennadher has received research support from Alzheimer's Disease Research Center at Boston University. The institution of Dr. Abdennadher has received research support from Alzheimer's Disease Research Center at Boston University. The institution of Dr. Abdennadher has received research support from Reddy/Blackstone.
Kushak Suchdev, MD (Boston School of Medicine, Neurology)	Dr. Suchdev has nothing to disclose.
Aneeta Saxena, MD (Biogen Idec)	An immediate family member of Dr. Saxena has received personal compensation for serving as an employee of BIogen.
Abrar Al-Faraj, MD (Boston University School of Medicine)	Dr. Al-Faraj has nothing to disclose.
Sanford H. Auerbach, MD, FAAN (Boston University Medical Center)	Dr. Auerbach has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
David M. Greer, MD, FAAN (Boston University School of Medicine)	Dr. Greer has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Thieme, Inc. Dr. Greer has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for multiple. The institution of Dr. Greer has received research support from Becton, Dickinson and Company. Dr. Greer has received publishing royalties from a publication relating to health care. Dr. Greer has received publishing royalties from a publication relating to health care.
Charlene J. Ong, MD (Boston University)	Dr. Ong has nothing to disclose.

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