Neurological outcome of postanoxic refractory status epilepticus after aggressive treatment

Simone Beretta, Anna Coppo, Elisa Bianchi, Clara Zanchi, Davide Carone, Andrea Stabile, Giada Padovano, Endrit Sulmina, Alice Grassi, Graziella Bogliun, Giuseppe Foti, Carlo Ferrarese, Antonio Pesenti, Ettore Beghi, Leonello Avalli

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Abstract

Refractory status epilepticus (RSE) occurs in up to 30% of patients following resuscitation after cardiac arrest. The impact of aggressive treatment of postanoxic RSE on long-term neurological outcome remains uncertain. We investigated neurological outcome of cardiac arrest patients with RSE treated with a standardized aggressive protocol with antiepileptic drugs and anesthetics, compared with patients with other electroencephalographic (EEG) patterns. A prospective cohort of 166 consecutive patients with cardiac arrest in coma was stratified according to four independent EEG patterns (benign; RSE; generalized periodic discharges (GPDs); malignant nonepileptiform) and multimodal prognostic indicators. Primary outcomes were survival and cerebral performance category (CPC) at 6 months. Refractory status epilepticus occurred in 36 patients (21.7%) and was treated with an aggressive standardized protocol as long as multimodal prognostic indicators were not unfavorable. Refractory status epilepticus started after 3 ± 2.3 days after cardiac arrest and lasted 4.7 ± 4.3 days. A benign EEG pattern was recorded in 76 patients (45.8%), a periodic pattern (GPDs) in 13 patients (7.8%), and a malignant nonepileptiform EEG pattern in 41 patients (24.7%). The four EEG patterns were highly associated with different prognostic indicators (low flow time, clinical motor seizures, N20 responses, neuron-specific enolase (NSE), neuroimaging). Survival and good neurological outcome (CPC 1 or 2) at 6 months were 72.4% and 71.1% for benign EEG pattern, 54.3% and 44.4% for RSE, 15.4% and 0% for GPDs, and 2.4% and 0% for malignant nonepileptiform EEG pattern, respectively. Aggressive and prolonged treatment of RSE may be justified in cardiac arrest patients with favorable multimodal prognostic indicators.

Original languageEnglish
Article number106374
JournalEpilepsy and Behavior
Volume101
Issue numberPt B
DOIs
Publication statusPublished - Dec 2019

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Keywords

  • Antiepileptic drugs
  • Cardiac arrest
  • Coma
  • EEG
  • Prognosis
  • Status epilepticus

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Behavioral Neuroscience

Cite this

Beretta, S., Coppo, A., Bianchi, E., Zanchi, C., Carone, D., Stabile, A., Padovano, G., Sulmina, E., Grassi, A., Bogliun, G., Foti, G., Ferrarese, C., Pesenti, A., Beghi, E., & Avalli, L. (2019). Neurological outcome of postanoxic refractory status epilepticus after aggressive treatment. Epilepsy and Behavior, 101(Pt B), [106374]. https://doi.org/10.1016/j.yebeh.2019.06.018