05/07/2026
⚙️ EEG: Pitfalls in Reactivity Testing
EEG reactivity is a cornerstone of coma prognostication, but misinterpretation is common, especially in sedated or critically ill patients. Distinguishing true non-reactivity from technical or pharmacologic suppression is essential for accurate reporting.
🧠 Why it matters: False “non-reactive” readings can lead to inaccurate prognoses. Sedatives, metabolic factors, or poor testing technique can mask cortical responsiveness without implying irreversible injury.
💡 Tech Tip – Avoid These Common Pitfalls:
1. Sedation Confounders – Agents like propofol, midazolam, or barbiturates can profoundly blunt reactivity. Always note the timing, dose, and weaning status when testing.
2. Artifact Misinterpretation – Movement, ventilator, or ECG artifacts can mimic “reactivity.” Confirm cortical origin across derivations.
3. Weak or Inconsistent Stimuli – Use firm, reproducible auditory, tactile, and noxious stimulation.
4. Single-Modality Testing – A patient may react to touch but not sound. Use multimodal testing for accuracy.
5. State Variability – Repeat testing during lighter background states; reactivity may emerge later.
6. Technical Oversights – Check filters, impedance, and montage setup before labeling “non-reactive.”
