Unstandardized treatment of electroencephalographic status epilepticus does not improve outcome of comatose patients after cardiac arrest
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 whi...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2014-03-01
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| Series: | Frontiers in Neurology |
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| Online Access: | http://journal.frontiersin.org/Journal/10.3389/fneur.2014.00039/full |
| _version_ | 1819045302939680768 |
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| author | Jeannette eHofmeijer Jeannette eHofmeijer Marleen C. eTjepkema-Cloostermans Michiel J. eBlans Albertus ebeishuizen Michel J.A.M. van Putten Michel J.A.M. van Putten |
| author_facet | Jeannette eHofmeijer Jeannette eHofmeijer Marleen C. eTjepkema-Cloostermans Michiel J. eBlans Albertus ebeishuizen Michel J.A.M. van Putten Michel J.A.M. van Putten |
| author_sort | Jeannette eHofmeijer |
| collection | DOAJ |
| description | 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/> |
| first_indexed | 2024-12-21T10:26:25Z |
| format | Article |
| id | doaj.art-de1234e0f7bd485e8cb758f9106f9380 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-12-21T10:26:25Z |
| publishDate | 2014-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-de1234e0f7bd485e8cb758f9106f93802022-12-21T19:07:18ZengFrontiers Media S.A.Frontiers in Neurology1664-22952014-03-01510.3389/fneur.2014.0003981163Unstandardized treatment of electroencephalographic status epilepticus does not improve outcome of comatose patients after cardiac arrestJeannette eHofmeijer0Jeannette eHofmeijer1Marleen C. eTjepkema-Cloostermans2Michiel J. eBlans3Albertus ebeishuizen4Michel J.A.M. van Putten5Michel J.A.M. van Putten6University of TwenteRijnstate HospitalUniversity of TwenteRijnstate HospitalMedical Spectrum TwenteUniversity of TwenteMedical Spectrum TwenteObjective<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/>http://journal.frontiersin.org/Journal/10.3389/fneur.2014.00039/fullStatus EpilepticusCardiac arrestprognosisEpileptic seizuresanti-epileptic drugsContinuous EEG |
| spellingShingle | Jeannette eHofmeijer Jeannette eHofmeijer Marleen C. eTjepkema-Cloostermans Michiel J. eBlans Albertus ebeishuizen Michel J.A.M. van Putten Michel J.A.M. van Putten Unstandardized treatment of electroencephalographic status epilepticus does not improve outcome of comatose patients after cardiac arrest Frontiers in Neurology Status Epilepticus Cardiac arrest prognosis Epileptic seizures anti-epileptic drugs Continuous EEG |
| 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 | Status Epilepticus Cardiac arrest prognosis Epileptic seizures anti-epileptic drugs Continuous EEG |
| url | http://journal.frontiersin.org/Journal/10.3389/fneur.2014.00039/full |
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