Neurologic outcome of postanoxic refractory status epilepticus after aggressive treatment
| Autor: | Anna Coppo, Giuseppe Foti, Alice Grassi, Simone Beretta, Ettore Beghi, Andrea Stabile, Giada Padovano, Elisa Bianchi, Graziella Bogliun, Carlo Ferrarese, Endrit Sulmina, Antonio Pesenti, Davide Carone, Leonello Avalli, Clara Zanchi |
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| Přispěvatelé: | 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 |
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Coma
status epilepticus medicine.diagnostic_test business.industry 030208 emergency & critical care medicine Status epilepticus Hypoxia (medical) Electroencephalography 03 medical and health sciences 0302 clinical medicine Refractory Anesthesia medicine In patient Neurology (clinical) medicine.symptom business Prospective cohort study 030217 neurology & neurosurgery Cohort study |
| Popis: | ObjectiveTo investigate neurologic outcome of patients with cardiac arrest with refractory status epilepticus (RSE) treated with a standardized aggressive protocol with antiepileptic drugs and anesthetics compared to patients with other EEG patterns.MethodsIn the prospective cohort study, 166 consecutive patients with cardiac arrest in coma were stratified according to 4 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.ResultsRSE occurred in 36 patients (21.7%) and was treated with an aggressive standardized protocol as long as multimodal prognostic indicators were not unfavorable. RSE 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) was seen in 13 patients (7.8%); and a malignant nonepileptiform EEG pattern was recorded in 41 patients (24.7%). The 4 EEG patterns were highly associated with different prognostic indicators (low-flow time, clinical motor seizures, N20 responses, neuron-specific enolase, neuroimaging). Survival and good neurologic 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.ConclusionsAggressive and prolonged treatment of RSE may be justified in patients with cardiac arrest with favorable multimodal prognostic indicators. |
| Databáze: | OpenAIRE |
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