A Single-Center Study on Nonconvulsive Status Epilepticus After Cardiac Arrest

  • Kazuhiro Sugiyama
  • Yuichi Hamabe


The prognostication of post-cardiac-arrest patients remains a challenge. Electroencephalography (EEG) is a promising modality; however, conventional EEG is difficult for non-neurologists to interpret. Amplitude-integrated EEG (aEEG) is quantitative EEG that is easy to interpret. aEEG is derived from continuous EEG with reduced electrode montage, with an easy setup. aEEG patterns have been useful in the prognostication of comatose post-cardiac-arrest patients. EEG is important in monitoring seizure activity in post-cardiac-arrest care. At the 44th Annual Meeting of the Japanese Society of Critical Care Medicine, we reported the incidence and characteristics of status epilepticus among patients treated with target temperature management and monitored with aEEG using a single bipolar frontal hairline lead. Seven of 61 patients (11%) revealed status epileptics, and 1 patient with continuous normal voltage before status epilepticus showed a good neurological outcome. aEEG monitoring with reduced leads has limited, but substantial, utility for detecting generalized seizure. Status epilepticus during post-cardiac-arrest care is not uniform: patients with status epilepticus are categorized into two groups based on the background pattern of aEEG before status epilepticus. Status epilepticus from continuous normal voltage is not always associated with poor outcomes. Knowledge of the background pattern can be gained, via aEEG monitoring, from the early phase after return of spontaneous circulation (ROSC). This could help identify targets of aggressive anticonvulsant therapy. Furthermore, aEEG monitoring is a useful tool for intensive and emergency physicians who treat post-cardiac-arrest patients at the bedside.


Amplitude-integrated electroencephalography Post-cardiac-arrest care Hypoxic encephalopathy Prognosis Status epilepticus 


  1. 1.
    Westhall E, Rossetti AO, van Rootselaar A-F, Wesenberg Kjaer T, Horn J, Ullén S, et al. Standardized EEG interpretation accurately predicts prognosis after cardiac arrest. Neurology. 2016;86(16):1482–90. Scholar
  2. 2.
    Lamartine Monteiro M, Taccone FS, Depondt C, Lamanna I, Gaspard N, Ligot N, et al. The prognostic value of 48-h continuous EEG during therapeutic hypothermia after cardiac arrest. Neurocrit Care. 2016;24(2):153–62. Scholar
  3. 3.
    Spalletti M, Carrai R, Scarpino M, Cossu C, Ammannati A, Ciapetti M, et al. Single electroencephalographic patterns as specific and time-dependent indicators of good and poor outcome after cardiac arrest. Clin Neurophysiol. 2016;127(7):2610–7. Scholar
  4. 4.
    Tjepkema-Cloostermans MC, Hofmeijer J, Trof RJ, Blans MJ, Beishuizen A, van Putten MJAM. Electroencephalogram predicts outcome in patients with postanoxic coma during mild therapeutic hypothermia. Crit Care Med. 2015;43(1):159–67. Scholar
  5. 5.
    Hellström-westas L. Amplitude-integrated EEG classification and interpretation in preterm and term infants. NeoReviews. 2006;7(2):76–97.CrossRefGoogle Scholar
  6. 6.
    Gluckman PD, Wyatt JS, Azzopardi D, Ballard R, Edwards AD, Ferriero DM, et al. Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial. Lancet. 2005;365(9460):663–70. Scholar
  7. 7.
    Rundgren M, Westhall E, Cronberg T, Rosén I, Friberg H. Continuous amplitude-integrated electroencephalogram predicts outcome in hypothermia-treated cardiac arrest patients. Crit Care Med. 2010;38(9):1838–44. Scholar
  8. 8.
    Oh SH, Park KN, Kim YM, Kim HJ, Youn CS, Kim SH, et al. The prognostic value of continuous amplitude-integrated electroencephalogram applied immediately after return of spontaneous circulation in therapeutic hypothermia-treated cardiac arrest patients. Resuscitation. 2013;84(2):200–5. Scholar
  9. 9.
    Thoresen M, Hellstrom-Westas L, Liu X, de Vries LS. Effect of hypothermia on amplitude-integrated electroencephalogram in infants with asphyxia. Pediatrics. 2010;126(1):e131–9. Scholar
  10. 10.
    Oh SH, Park KN, Shon YM, Kim YM, Kim HJ, Youn CS, et al. Continuous amplitude-integrated electroencephalographic monitoring is a useful prognostic tool for hypothermia-treated cardiac arrest patients. Circulation. 2015;132(12):1094–103. Scholar
  11. 11.
    Nolan JP, Soar J, Cariou A, Cronberg T, Moulaert VR, Deakin CD, et al. European Resuscitation Council and European Society of Intensive Care Medicine Guidelines for post-resuscitation care 2015: section 5 of the European resuscitation council guidelines for resuscitation. Resuscitation. 2015;95:202–22. Scholar
  12. 12.
    Callaway CW, Donnino MW, Fink EL, Geocadin RG, Golan E, Kern KB, et al. Part 8: post–cardiac arrest care. Circulation. 2015;132(18 suppl 2):S465–82. Scholar
  13. 13.
    Rittenberger JC, Popescu A, Brenner RP, Guyette FX, Callaway CW. Frequency and timing of nonconvulsive status epilepticus in comatose post-cardiac arrest subjects treated with hypothermia. Neurocrit Care. 2012;16(1):114–22. Scholar
  14. 14.
    Legriel S, Hilly-Ginoux J, Resche-Rigon M, Merceron S, Pinoteau J, Henry-Lagarrigue M, et al. Prognostic value of electrographic postanoxic status epilepticus in comatose cardiac-arrest survivors in the therapeutic hypothermia era. Resuscitation. 2013;84(3):343–50. Scholar
  15. 15.
    Mani R, Schmitt SE, Mazer M, Putt ME, Gaieski DF. The frequency and timing of epileptiform activity on continuous electroencephalogram in comatose post-cardiac arrest syndrome patients treated with therapeutic hypothermia. Resuscitation. 2012;83(7):840–7. Scholar
  16. 16.
    Rossetti AO, Logroscino G, Liaudet L, Ruffieux C, Ribordy V, Schaller MD, et al. Status epilepticus: an independent outcome predictor after cerebral anoxia. Neurology. 2007;69(3):255–60. Scholar
  17. 17.
    Friberg H, Westhall E, Rosén I, Rundgren M, Nielsen N, Cronberg T. Clinical review: continuous and simplified electroencephalography to monitor brain recovery after cardiac arrest. Crit Care. 2013;17(4):233. Scholar
  18. 18.
    Ruijter BJ, Van Putten MJ, Horn J, Blans MJ, Beishuizen A, Van Rootselaar A-F, et al. Treatment of electroencephalographic status epilepticus after cardiopulmonary resuscitation (TELSTAR): study protocol for a randomized controlled trial. Trials. 2014;6(15):433. Scholar
  19. 19.
    Nitzschke R, Müller J, Engelhardt R, Schmidt GN. Single-channel amplitude integrated EEG recording for the identification of epileptic seizures by nonexpert physicians in the adult acute care setting. J Clin Monit Comput. 2011;25(5):329–37. Scholar
  20. 20.
    Dericioglu N, Yetim E, Bas DF, Bilgen N, Caglar G, Arsava EM, et al. Non-expert use of quantitative EEG displays for seizure identification in the adult neuro-intensive care unit. Epilepsy Res. 2015;109:48–56. Scholar
  21. 21.
    Rubin MN, Jeffery OJ, Fugate JE, Britton JW, Cascino GD, Worrell GA, et al. Efficacy of a reduced electroencephalography electrode array for detection of seizures. Neurohospitalist. 2014;4(1):6–8. Scholar
  22. 22.
    Ma BB, Johnson EL, Ritzl EK. Sensitivity of a reduced EEG montage for seizure detection in the neurocritical care setting. J Clin Neurophysiol. 2018;1:256. Scholar
  23. 23.
    Karakis I, Montouris GD, Otis JAD, Douglass LM, Jonas R, Velez-Ruiz N, et al. A quick and reliable EEG montage for the detection of seizures in the critical care setting. J Clin Neurophysiol. 2010;27(2):100–5. Scholar
  24. 24.
    Kolls BJ, Husain AM. Assessment of hairline EEG as a screening tool for nonconvulsive status epilepticus. Epilepsia. 2007;48(5):959–65. Scholar
  25. 25.
    Young GB, Sharpe MD, Savard M, Al Thenayan E, Norton L, Davies-Schinkel C. Seizure detection with a commercially available bedside EEG monitor and the subhairline montage. Neurocrit Care. 2009;11(3):411–6. Scholar
  26. 26.
    Brenner JM, Kent P, Wojcik SM, Grant W. Rapid diagnosis of nonconvulsive status epilepticus using reduced-lead electroencephalography. West J Emerg Med. 2015;16(3):442–6. Scholar
  27. 27.
    Vanherpe P, Schrooten M. Minimal EEG montage with high yield for the detection of status epilepticus in the setting of postanoxic brain damage. Acta Neurol Belg. 2017;117(1):145–52. Scholar
  28. 28.
    Leitinger M, Beniczky S, Rohracher A, Gardella E, Kalss G, Qerama E, et al. Salzburg consensus criteria for non-convulsive status epilepticus—approach to clinical application. Epilepsy Behav. 2015;49:158–63. Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  • Kazuhiro Sugiyama
    • 1
  • Yuichi Hamabe
    • 1
  1. 1.Tertiary Emergency Medical CenterTokyo Metropolitan Bokutoh HospitalTokyoJapan

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