AUTHOR=Hofmeijer Jeannette , Tjepkema-Cloostermans Marleen C. , Blans Michiel J. , beishuizen Albertus , van Putten Michel J.

TITLE=Unstandardized Treatment of Electroencephalographic Status Epilepticus Does Not Improve Outcome of Comatose Patients after Cardiac Arrest

JOURNAL=Frontiers in Neurology

VOLUME=Volume 5 - 2014

YEAR=2014

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2014.00039

DOI=10.3389/fneur.2014.00039

ISSN=1664-2295

ABSTRACT=Objective<br/>Electroencephalographic status epilepticus occurs in 9-35% of comatose patients after cardiac arrest. Mortality is 90-100%. It is unclear whether (some) seizure patterns represent a condition in which anti-epileptic treatment may improve outcome, or severe ischemic damage, in which treatment is futile. We explored current treatment practice and its effect on patients’ outcome.<br/><br/>Methods<br/>We retrospectively identified patients that were treated with anti-epileptic drugs from our prospective cohort study on the value of continuous EEG in comatose patients after cardiac arrest. Outcome at six months was dichotomized between “good” (CPC 1 or 2) and “poor” (CPC 3, 4, or 5). EEG analyses were done at 24 hours after cardiac arrest and during anti-epileptic treatment. Unequivocal seizures and generalized periodic discharges during more than 30 minutes were classified as status epilepticus.<br/><br/>Results<br/>Thirty-one (22%) out of 139 patients were treated with anti-epileptic drugs (phenytoin, levetiracetam, valproate, clonazepam, propofol, midazolam), of whom 24 had status epilepticus. Dosages were moderate, barbiturates were not used, medication induced burst-suppression not achieved, and treatment improved electroencephalographic status epilepticus patterns temporarily (< six hours). Twenty-three patients treated for status epilepticus (96%) died. In patients with status epilepticus at 24 hours, there was no difference in outcome between those treated with and without anti-epileptic drugs.<br/><br/>Conclusions<br/>In comatose patients after cardiac arrest complicated by electroencephalographic status epilepticus, current practice includes unstandardized, moderate treatment with anti-epileptic drugs. Although widely used, this does probably not improve patients’ outcome. A randomized controlled trial to estimate the effect of standardized, aggressive treatment, directed at complete suppression of epileptiform activity during at least 24 hours, is needed and in preparation.<br/>