Frequency and Timing of Nonconvulsive Status Epilepticus in Comatose Post-Cardiac Arrest Subjects Treated with Hypothermia
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Therapeutic hypothermia (TH) improves outcomes in comatose patients resuscitated from cardiac arrest. However, nonconvulsive status epilepticus (NCSE) may cause persistent coma. The frequency and timing of NCSE after cardiac arrest is unknown.
Review of consecutive subjects treated with TH and receiving continuous EEG (cEEG) monitoring between 8/1/2009 and 11/16/2010. Demographic data, survival, and functional outcome were prospectively recorded. Each cEEG file was analyzed using standard definitions to define NCSE. Data were analyzed using descriptive and nonparametric statistics.
Mean age of the 101 subjects was 57 years (SD 15) with most subjects being male (N = 55, 54%) and experiencing out-of-hospital cardiac arrest (N = 78; 77%). Ventricular fibrillation was the initial cardiac rhythm in 39 (38%). All subjects received TH. Thirty subjects (30%) awoke at a median of 41 h (IQR 30, 61) after cardiac arrest. A total of 29/30 (97%) subjects surviving to hospital discharge were awake. Median interval from arrest to placement of cEEG was 9 h (IQR 6, 12), at which time the mean temperature was 33.9°C. NCSE occurred in 12 (12%) subjects. In 3/12 (25%) subjects, NCSE was present when the cEEG recording began. In 4 subjects, NCSE occurred within 8 h of cEEG recording. One (8%) subject with NCSE survived in a vegetative state.
NCSE is common in comatose post-cardiac arrest subjects receiving TH. Most seizures occur within the first 8 h of cEEG recording and within the first 12 h after resuscitation from cardiac arrest. Outcomes are poor in those who experience NCSE.
- Nichol G, Thomas E, Callaway CW, et al. Regional variation in out-of-hospital cardiac arrest incidence and outcome. JAMA. 2008;300:1423–31.
- Rittenberger JC, Holm MB, Guyette FX, Tisherman SA, Callaway CW. An early, novel illness severity score to predict outcome after cardiac arrest. Resuscitation. 2011 (in press).
- Hypothermia After Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002;346:549–56. CrossRef
- Bernard SA, Gray TW, Buist MD, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med. 2002;346:557–63. CrossRef
- Sunde K, Pytte M, Jacobsen D, et al. Implementation of a standardized treatment protocol for post resuscitation care after out-of-hospital cardiac arrest. Resuscitation. 2007;73:29–39. CrossRef
- Rittenberger JC, Guyette FX, Tisherman SA, DeVita MA, Alvarez RJ, Callaway CW. Implementation of a hospital-wide plan to improve care of comatose survivors of cardiac arrest. Resuscitation. 2008;79:198–204. CrossRef
- Rossetti AO, Oddo M, Liaudet L, Kaplan PW. Predictors of awakening from postanoxic status epilepticus after therapeutic hypothermia. Neurology. 2009;72:744–9. CrossRef
- Vespa PM, Ronne-Engstrom E, Smith, et al. Increase in extracellular glutamate caused by reduced cerebral perfusion pressure and seizures after human traumatic brain injury: a microdialysis study. J Neurosurgery. 1998;89:971–82.
- Vespa P, Martin NA, Nenov V, et al. Delayed increase in extracellular glycerol with post-traumatic electrographic seizure activity: support for the theory that seizures induce secondary injury. Acta Neurol Suppl. 2002;81:355–7.
- Claassen J, Mayer SA, Kowalski RG, Emerson RG, Hirsch LJ. Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology. 2004;62:1743–8.
- Abend NS, Topjian A, Ichord R, Herman ST, Helfaer M, Donnelly M, Nadkarni V, Dlugos DJ, Clancy RR. Electroencephalographic monitoring during hypothermia after pediatric cardiac arrest. Neurology. 2009;72:1931–40. CrossRef
- Rundgren M, Rosen I, Fribert H. Amplitude integrated EEG (aEEG) predicts outcome after ardiac arrest and induced hypothermia. Intensive Care Med. 2006;32:836–42. CrossRef
- Krumholz A, Stern BJ, Weiss HD. Outcome from coma after cardiopulmonary resuscitation: relation to seizures and myoclonus. Neurology. 1988;38:401–5.
- Nielsen N, Sunde K, Hovdenes J, Riker RR, Rubertsson S, Stammet P, Nilsson F, Friberg H. Hypothermia network. Adverse events and their relation to mortality in out-of-hospital cardiac arrest patients treated with therapeutic hypothermia. Crit Care Med. 2011;39:57–64.
- Rittenberger JC, Raina K, Holm MB, Kim YJ, Callaway CW. Association between cerebral performance category, modified ranking scale, and discharge disposition after cardiac arrest. Resuscitation 2011 Apr 13 [Epub ahead of print].
- Thomke F, Weilemann SL. Poor prognosis despite successful treatment of postanoxic generalized myoclonus. Neurology. 2010;74:1392–5. CrossRef
- Brenner RP. EEG in convulsive and nonconvulsive status epilepticus. J Clin Neurophysiol. 2004;21(5):319–31.
- Chong DJ, Hrisch LJ. Which EEG patterns warrant treatment in the critically ill? Reviewing the evidence for treatment of periodic epileptiform discharges and related patterns. J Clin Neurophysiol. 2005;22:79–91.
- Kaplan PW. EEG criteria for nonconvulsive status epilepticus. Epilepsia. 2007;48(suppl 8):39–41. CrossRef
- Young GB, Jordan KG, Doig GS. An assessment of nonconvulsive seizures in the intensive care unit using continuous EEG monitoring. Neurology. 1996;47:83–9.
- Iyer VN, Mandrekar JN, Danielson RD, Zubkov AY, Elmer JL, Wijdicks EF. Validity of the FOUR score coma scale in the medical intensive care unit. Mayo Clin Proc. 2009;84:694–701. CrossRef
- Pettila V, Pettila M, Sarna S, et al. Comparison of multiple organ dysfunction scores in the prediction of hospital mortality in the critically ill. Crit Care Med. 2002;30:1705–11. CrossRef
- Peberdy MA, Callaway CW, Neumar RW, Geocadin RG, Zimmerman JL, Donnino M, Gabrielli A, Silvers SM, Zaritsky AL, Merchant R, Vanden Hoek TL, Kronick SL. Part 9: Post-cardiac arrest care: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2010;122:S768–86. CrossRef
- Rossetti AO, Oddo M, Logroscino G, Kaplan PW. Prognostication after cardiac arrest and hypothermia. A prospective study. Ann Neurol. 2010;67:301–7.
- Fugate JE, Wijdicks EFM, Mandrekar J, Claassen DO, Manno EM, White RD, Bell MR, Rabinstein AA. Predictors of neurologic outcome in hypothermia after cardiac arrest. Ann Neurol. 2010;68:907–14. CrossRef
- Szaflarski JP, Sangha KS, Lindsell CJ, Shutter LA. Prospective, randomized, single-blinded comparative trial of intravenous levetiracetam versus phenytoin for seizure prophylaxis. Neurocrit Care. 2010;12:165–72. CrossRef
- Hanon E, Klitgaard H. Neuroprotective properties of the novel antiepileptic drug levetiracetam in the rate middle cerebral artery occlusion model of focal cerebral ischemia. Seizure. 2001;19:287–93. CrossRef
- Brain Resuscitation Clinical Trial I Study Group. Randomized clinical study of thiopental loading in comatose survivors of cardiac arrest. N Engl J Med. 1986;314:397–403. CrossRef
- Longstreth WT Jr, Fahrenbruch CE, Olsufka M, Walsh TR, Copass MK, Cobb LA. Randomized clinical trial of magnesium, diazepam, or both after out-of-hospital cardiac arrest. Neurology. 2002;59:506–14.
- Frequency and Timing of Nonconvulsive Status Epilepticus in Comatose Post-Cardiac Arrest Subjects Treated with Hypothermia
Volume 16, Issue 1 , pp 114-122
- Cover Date
- Print ISSN
- Online ISSN
- Humana Press Inc
- Additional Links
- Cardiac arrest
- Status epilepticus
- Anoxic brain injury
- Industry Sectors
- Author Affiliations
- 1. Department of Emergency Medicine, University of Pittsburgh, Iroquois Building, Suite 400A, 3600 Forbes Avenue, Pittsburgh, PA, 15261, USA
- 2. Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA