ArticleNeurocritical care2026
EEG Reactivity and Etiology as Prognostic Modifiers in Alpha and Theta Coma: A Systematic Review and Meta-analysis.
Article in Neurocritical care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAlpha/theta coma is an uncommon electroencephalographic (EEG) pattern observed in deeply comatose patients and has traditionally been regarded as a malignant finding, particularly after hypoxic-ischemic injury following cardiac arrest. Classically, it is associated with a nonreactive alpha/theta rhythm and high mortality. However, occasional neurological recovery suggests greater prognostic heterogeneity than historically believed, while it remains uncertain whether historical diagnostic definitions of alpha/theta coma are comparable with contemporary concepts of disorders of consciousness. We conducted a systematic review and meta-analysis to clarify outcome heterogeneity, identify prognostic modifiers associated with recovery, and re-appraise the historical literature.
methodsA systematic search of PubMed, EMBASE, and Cochrane databases was conducted through December 2025. Original human studies reporting outcomes in comatose patients with alpha coma, theta coma, or alpha-theta coma were included. Functional outcomes were categorized into four ordinal categories. Random- or common-effects models were applied according to heterogeneity. Prespecified prognostic analyses focused on EEG reactivity.
resultsSix studies (n = 152) were included. Overall, 83.7% (95% CI 76.8-88.8%, I
conclusionsAlpha/theta coma is not uniformly fatal. EEG reactivity identifies a lower-risk subgroup without guaranteeing recovery, while etiology further shapes prognosis. These findings should be interpreted in the context of historical diagnostic uncertainty, and contemporary studies are needed to better define alpha/theta coma using current concepts of disorders of consciousness.
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