What does burst suppression really mean?

- Burst suppression refers to an electrographic (EEG) pattern associated with coma
- The dynamic of burst suppression is situated between slow-wave sleep-like patterns
- Burst suppression is a state of cortical hyperexcitability due to compromised inhibition
- The pharmacological approach to burst suppression aims at shifting the brain away from its hyperexcitable window.

This paper describes the various electroencephalographic (EEG) patterns expressed by the comatose brain, starting with the sleep-like oscillations associated with light coma. Deeper coma generally displays a burst-suppression pattern characterized by alternating episodes of isoelectric (flat) EEG and bursting slow waves. The latter are the result of cortical hyperexcitability, as demonstrated by intracellular recordings in anesthetized animals. Further deepening of the coma yields to continuous isoelectric electroencephalogram and eventually results in a newly discovered type of spiky waves that have been termed Nu-complexes. The paper discusses the structures participating in the genesis of burst suppression, the afferent mechanisms, and the reasons for which this activity should or should not be regarded as an epileptic disorder.This article is part of a Special Issue entitled “Status Epilepticus”.