Skip to main content

Advertisement

SpringerLink
Log in

Early EEG Monitoring for Detecting Postanoxic Status Epilepticus during Therapeutic Hypothermia: A Pilot Study

  • Original Article
  • Published:
Neurocritical Care Aims and scope Submit manuscript

Abstract

Objective

To determine whether routine electroencephalography (EEG) detected electrical status epilepticus (ESE), masked by neuromuscular blockade, in comatose cardiac-arrest survivors receiving therapeutic hypothermia.

Design

Prospective 3-year study

Setting

Medical ICU

Patients

Fifty-one consecutive comatose cardiac-arrest patients treated between May 2005 and May 2008 using a standardized protocol of hypothermia with neuromuscular blockade.

Intervention

EEG was performed routinely as soon as possible after starting therapeutic hypothermia. EEG recordings were read by an independent neurophysiologist who was blinded to patient data.

Measurements and Main Results

Median body temperature at EEG recording was 33.0°C (range 32.4–33.8). ESE was found on 5 (10%) of the 51 EEG recordings: three patients had continuous rhythmic generalized spikes and two patients had continuous rhythmic focal spike-waves. Of the 17 (33%) patients who were discharged alive, 8 (8/51, 16%) had a CPC score of 1, 4 (8%) of 2, and 5 (10%) of 3. All patients with ESE died during their ICU stay.

Conclusion

These preliminary results indicate that postanoxic status epilepticus can be masked by neuromuscular blockade during our protocol of therapeutic hypothermia. Routine EEG monitoring might be helpful in cardiac-arrest survivors receiving therapeutic hypothermia. Further studies including continuous EEG monitoring are needed to determine whether early diagnosis and treatment of ESE during therapeutic hypothermia improves the outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Nolan JP, Deakin CD, Soar J, Bottiger BW, Smith G. European Resuscitation Council guidelines for resuscitation 2005. Sect. 4. Adult advanced life support. Resuscitation. 2005;67(Suppl 1):S39–86.

    Article  PubMed  Google Scholar 

  2. Wijdicks EF, Hijdra A, Young GB, Bassetti CL, Wiebe S. Practice parameter: prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2006;67:203–10.

    Article  CAS  PubMed  Google Scholar 

  3. Krumholz A, Stern BJ, Weiss HD. Outcome from coma after cardiopulmonary resuscitation: relation to seizures and myoclonus. Neurology. 1988;38:401–5.

    CAS  PubMed  Google Scholar 

  4. Fujikawa DG. Prolonged seizures and cellular injury: understanding the connection. Epilepsy Behav. 2005;7(Suppl 3):S3–11.

    Article  PubMed  Google Scholar 

  5. Schmitt FC, Buchheim K, Meierkord H, Holtkamp M. Anticonvulsant properties of hypothermia in experimental status epilepticus. Neurobiol Dis. 2006;23:689–96.

    Article  CAS  PubMed  Google Scholar 

  6. Neumar RW, Nolan JP, Adrie C, et al. Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A consensus statement from the International Liaison Committee on Resuscitation (American Heart Association, Australian and New Zealand Council on Resuscitation, European Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Asia, and the Resuscitation Council of Southern Africa); the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; and the Stroke Council. Circulation. 2008;118:2452–83.

    Article  PubMed  Google Scholar 

  7. Adnet F, Lapostolle F. International EMS systems: France. Resuscitation. 2004;63:7–9.

    Article  PubMed  Google Scholar 

  8. Nolan JP, Morley PT, Hoek TL, Hickey RW. Therapeutic hypothermia after cardiac arrest. An advisory statement by the Advancement Life support Task Force of the International Liaison Committee on Resuscitation. Resuscitation. 2003;57:231–5.

    Article  PubMed  Google Scholar 

  9. Polderman KH, Rijnsburger ER, Peerdeman SM, Girbes AR. Induction of hypothermia in patients with various types of neurologic injury with use of large volumes of ice-cold intravenous fluid. Crit Care Med. 2005;33:2744–51.

    Article  PubMed  Google Scholar 

  10. Jacobs I, Nadkarni V, Bahr J, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Councils of Southern Africa). Circulation. 2004;110:3385–97.

    Article  PubMed  Google Scholar 

  11. Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA. 1993;270:2957–63.

    Article  CAS  PubMed  Google Scholar 

  12. Le Gall JR, Klar J, Lemeshow S, et al. The Logistic Organ Dysfunction system. A new way to assess organ dysfunction in the intensive care unit. ICU Scoring Group. JAMA. 1996;276:802–10.

    Article  CAS  PubMed  Google Scholar 

  13. Young GB, Gilbert JJ, Zochodne DW. The significance of myoclonic status epilepticus in postanoxic coma. Neurology. 1990;40:1843–8.

    CAS  PubMed  Google Scholar 

  14. Wijdicks EF, Parisi JE, Sharbrough FW. Prognostic value of myoclonus status in comatose survivors of cardiac arrest. Ann Neurol. 1994;35:239–43.

    Article  CAS  PubMed  Google Scholar 

  15. Thomke F, Marx JJ, Sauer O, et al. Observations on comatose survivors of cardiopulmonary resuscitation with generalized myoclonus. BMC Neurol. 2005;5:14.

    Article  PubMed  Google Scholar 

  16. Kaplan PW. The EEG of status epilepticus. J Clin Neurophysiol. 2006;23:221–9.

    Article  PubMed  Google Scholar 

  17. Walker M, Cross H, Smith S, et al. Non convulsive status epilepticus : Epilepsy Research Foundation Workshop Reports. Epileptic Disord. 2005;7:253–96.

    PubMed  Google Scholar 

  18. Maeda T, Hashizume K, Tanaka T. Effect of hypothermia on kainic acid-induced limbic seizures: an electroencephalographic and 14C-deoxyglucose autoradiographic study. Brain Res. 1999;818:228–35.

    Article  CAS  PubMed  Google Scholar 

  19. Liu Z, Gatt A, Mikati M, Holmes GL. Effect of temperature on kainic acid-induced seizures. Brain Res. 1993;631:51–8.

    Article  CAS  PubMed  Google Scholar 

  20. Orlowski JP, Erenberg G, Lueders H, Cruse RP. Hypothermia and barbiturate coma for refractory status epilepticus. Crit Care Med. 1984;12:367–72.

    Article  CAS  PubMed  Google Scholar 

  21. Corry JJ, Dhar R, Murphy T, Diringer MN. Hypothermia for refractory status epilepticus. Neurocrit Care. 2008;9:189–97.

    Article  CAS  PubMed  Google Scholar 

  22. Lundgren J, Smith ML, Blennow G, Siesjo BK. Hyperthermia aggravates and hypothermia ameliorates epileptic brain damage. Exp Brain Res. 1994;99:43–55.

    Article  CAS  PubMed  Google Scholar 

  23. Ohmori H, Sato Y, Namiki A. The anticonvulsant action of propofol on epileptiform activity in rat hippocampal slices. Anesth Analg. 2004;99:1095–101. table of contents.

    Article  CAS  PubMed  Google Scholar 

  24. Holtkamp M, Tong X, Walker MC. Propofol in subanesthetic doses terminates status epilepticus in a rodent model. Ann Neurol. 2001;49:260–3.

    Article  CAS  PubMed  Google Scholar 

  25. Parviainen I, Uusaro A, Kalviainen R, Mervaala E, Ruokonen E. Propofol in the treatment of refractory status epilepticus. Intensive Care Med. 2006;32:1075–9.

    Article  CAS  PubMed  Google Scholar 

  26. Meierkord H, Boon P, Engelsen B, et al. EFNS guideline on the management of status epilepticus. Eur J Neurol. 2006;13:445–50.

    Article  CAS  PubMed  Google Scholar 

  27. Leslie K, Sessler DI, Bjorksten AR, Moayeri A. Mild hypothermia alters propofol pharmacokinetics and increases the duration of action of atracurium. Anesth Analg. 1995;80:1007–14.

    Article  CAS  PubMed  Google Scholar 

  28. Legriel S, Troche G, Bedos JP. Status epilepticus after discontinuation of induced hypothermia—an incidental association? Resuscitation. 2006;70:159.

    Article  PubMed  Google Scholar 

  29. Battin M, Bennet L, Gunn AJ. Rebound seizures during rewarming. Pediatrics. 2004;114:1369.

    Article  PubMed  Google Scholar 

  30. Rundgren M, Rosen I, Friberg H. Amplitude-integrated EEG (aEEG) predicts outcome after cardiac arrest and induced hypothermia. Intensive Care Med. 2006;32:836–42.

    Article  PubMed  Google Scholar 

  31. Jirsch J, Hirsch LJ. Nonconvulsive seizures: developing a rational approach to the diagnosis and management in the critically ill population. Clin Neurophysiol. 2007;118:1660–70.

    Article  CAS  PubMed  Google Scholar 

  32. Rossetti AO, Logroscino G, Liaudet L, et al. Status epilepticus: an independent outcome predictor after cerebral anoxia. Neurology. 2007;69:255–60.

    Article  CAS  PubMed  Google Scholar 

  33. Rossetti AO, Oddo M, Liaudet L, Kaplan PW. Predictors of awakening from postanoxic status epilepticus after therapeutic hypothermia. Neurology. 2009;72:744–9.

    Article  PubMed  Google Scholar 

  34. Legriel S, Mourvillier B, Bele N, et al. Outcomes in 140 critically ill patients with status epilepticus. Intensive Care Med. 2008;34:476–80.

    Article  PubMed  Google Scholar 

  35. Hypothermia after Cardiac Arrest Study Group, et al. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002;346:549–56.

    Article  Google Scholar 

  36. 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.

    Article  PubMed  Google Scholar 

  37. Oddo M, Schaller MD, Feihl F, Ribordy V, Liaudet L. From evidence to clinical practice: effective implementation of therapeutic hypothermia to improve patient outcome after cardiac arrest. Crit Care Med. 2006;34:1865–73.

    PubMed  Google Scholar 

  38. Gueugniaud PY, David JS, Chanzy E, et al. Vasopressin and epinephrine vs. epinephrine alone in cardiopulmonary resuscitation. N Engl J Med. 2008;359:21–30.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgment

We thank A. Wolfe MD for helping to prepare the manuscript.

Author information

Authors and Affiliations

  1. Intensive Care Unit, Service de Réanimation medico-chirurgicale, Hôpital André Mignot, University Versailles-Saint-Quentin, 177 rue de Versailles, 78150, Le Chesnay Cedex, France

    Stéphane Legriel, Fabrice Bruneel, Julia Hilly, Nathalie Abbosh, Matthieu Henry Lagarrigue, Gilles Troche, Pierre Guezennec & Jean Pierre Bedos

  2. Clinical Neurophysiology and Neurology Department, Hôpital Roger Salengro, CHRU Lille, rue du Pr. Emile Laine, 59037, Lille Cedex, France

    Haouaria Sediri

  3. Neurology Department, Hôpital André Mignot, University Versailles-Saint-Quentin, 177 rue de Versailles, 78150, Le Chesnay Cedex, France

    Fernando Pico

Authors
  1. Stéphane Legriel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fabrice Bruneel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Haouaria Sediri
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Julia Hilly
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nathalie Abbosh
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Matthieu Henry Lagarrigue
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Gilles Troche
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Pierre Guezennec
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Fernando Pico
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jean Pierre Bedos
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stéphane Legriel.

Additional information

This study was performed in the Intensive care unit of André Mignot Hospital, France.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Legriel, S., Bruneel, F., Sediri, H. et al. Early EEG Monitoring for Detecting Postanoxic Status Epilepticus during Therapeutic Hypothermia: A Pilot Study. Neurocrit Care 11, 338–344 (2009). https://doi.org/10.1007/s12028-009-9246-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12028-009-9246-4

Keywords

Search

Navigation