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Unstandardized Treatment of Electroencephalographic Status Epilepticus Does Not Improve Outcome of Comatose Patients after Cardiac Arrest
Objective: 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 treatm...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Frontiers Media S.A.
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3978332/ https://www.ncbi.nlm.nih.gov/pubmed/24744748 http://dx.doi.org/10.3389/fneur.2014.00039 |
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author | Hofmeijer, Jeannette Tjepkema-Cloostermans, Marleen C. Blans, Michiel J. Beishuizen, Albertus van Putten, Michel J. A. M. |
author_facet | Hofmeijer, Jeannette Tjepkema-Cloostermans, Marleen C. Blans, Michiel J. Beishuizen, Albertus van Putten, Michel J. A. M. |
author_sort | Hofmeijer, Jeannette |
collection | PubMed |
description | Objective: 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. Methods: We retrospectively identified patients that were treated with anti-epileptic drugs from our prospective cohort study on the value of continuous electroencephalography (EEG) in comatose patients after cardiac arrest. Outcome at 6 months was dichotomized between “good” [cerebral performance category (CPC) 1 or 2] and “poor” (CPC 3, 4, or 5). EEG analyses were done at 24 h after cardiac arrest and during anti-epileptic treatment. Unequivocal seizures and generalized periodic discharges during more than 30 min were classified as status epilepticus. Results: 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 (<6 h). Twenty-three patients treated for status epilepticus (96%) died. In patients with status epilepticus at 24 h, there was no difference in outcome between those treated with and without anti-epileptic drugs. Conclusion: 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 h, is needed and in preparation. |
format | Online Article Text |
id | pubmed-3978332 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-39783322014-04-17 Unstandardized Treatment of Electroencephalographic Status Epilepticus Does Not Improve Outcome of Comatose Patients after Cardiac Arrest Hofmeijer, Jeannette Tjepkema-Cloostermans, Marleen C. Blans, Michiel J. Beishuizen, Albertus van Putten, Michel J. A. M. Front Neurol Neuroscience Objective: 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. Methods: We retrospectively identified patients that were treated with anti-epileptic drugs from our prospective cohort study on the value of continuous electroencephalography (EEG) in comatose patients after cardiac arrest. Outcome at 6 months was dichotomized between “good” [cerebral performance category (CPC) 1 or 2] and “poor” (CPC 3, 4, or 5). EEG analyses were done at 24 h after cardiac arrest and during anti-epileptic treatment. Unequivocal seizures and generalized periodic discharges during more than 30 min were classified as status epilepticus. Results: 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 (<6 h). Twenty-three patients treated for status epilepticus (96%) died. In patients with status epilepticus at 24 h, there was no difference in outcome between those treated with and without anti-epileptic drugs. Conclusion: 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 h, is needed and in preparation. Frontiers Media S.A. 2014-03-31 /pmc/articles/PMC3978332/ /pubmed/24744748 http://dx.doi.org/10.3389/fneur.2014.00039 Text en Copyright © 2014 Hofmeijer, Tjepkema-Cloostermans, Blans, Beishuizen and van Putten. http://creativecommons.org/licenses/by/3.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Neuroscience Hofmeijer, Jeannette Tjepkema-Cloostermans, Marleen C. Blans, Michiel J. Beishuizen, Albertus van Putten, Michel J. A. M. Unstandardized Treatment of Electroencephalographic Status Epilepticus Does Not Improve Outcome of Comatose Patients after Cardiac Arrest |
title | Unstandardized Treatment of Electroencephalographic Status Epilepticus Does Not Improve Outcome of Comatose Patients after Cardiac Arrest |
title_full | Unstandardized Treatment of Electroencephalographic Status Epilepticus Does Not Improve Outcome of Comatose Patients after Cardiac Arrest |
title_fullStr | Unstandardized Treatment of Electroencephalographic Status Epilepticus Does Not Improve Outcome of Comatose Patients after Cardiac Arrest |
title_full_unstemmed | Unstandardized Treatment of Electroencephalographic Status Epilepticus Does Not Improve Outcome of Comatose Patients after Cardiac Arrest |
title_short | Unstandardized Treatment of Electroencephalographic Status Epilepticus Does Not Improve Outcome of Comatose Patients after Cardiac Arrest |
title_sort | unstandardized treatment of electroencephalographic status epilepticus does not improve outcome of comatose patients after cardiac arrest |
topic | Neuroscience |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3978332/ https://www.ncbi.nlm.nih.gov/pubmed/24744748 http://dx.doi.org/10.3389/fneur.2014.00039 |
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