The frequency and timing of epileptiform activity on continuous electroencephalogram in comatose post-cardiac arrest syndrome patients treated with therapeutic hypothermia

Mani, Ram S.; Schmitt, Sarah; Mazer, Maryann; Putt, Mary; Gaieski, David F.

doi:10.1016/j.resuscitation.2012.02.015

Cited by 137 publications

(91 citation statements)

References 16 publications

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“…37 In patients treated with TH, continuous EEG monitoring is frequently used for evaluation of background activity or reactivity and for the detection of subclinical seizures or nonconvulsive status epilepticus and to distinguish seizures from myoclonic status epilepticus. In addition, continuous EEG monitoring is being increasingly used in patients undergoing TH to detect seizures during induced paralysis or severe shivering, partly due to the 34 In this study, the median onset of seizures was 19 hours following CA, a period when most patients treated with TH are typically under pharmacologic paralysis or heavy sedation. 34 In this study, a poor neurologic outcome was seen in 94% of the patients with any epileptiform activity and in 100% of the patients with electrographic seizures.…”

Section: Seizures and Eegmentioning

confidence: 96%

“…In addition, continuous EEG monitoring is being increasingly used in patients undergoing TH to detect seizures during induced paralysis or severe shivering, partly due to the 34 In this study, the median onset of seizures was 19 hours following CA, a period when most patients treated with TH are typically under pharmacologic paralysis or heavy sedation. 34 In this study, a poor neurologic outcome was seen in 94% of the patients with any epileptiform activity and in 100% of the patients with electrographic seizures. Another retrospective study of 54 patients undergoing TH after CA also showed a poor outcome in patient with seizures or epileptiform discharges despite treatment.…”

Section: Seizures and Eegmentioning

confidence: 96%

“…33 MSE is a clinical definition that is applied to comatose patients who develop 5 to 30 minutes of generalized and continuous myoclonus within 24 hours after CA. 34,35 MSE is considered an agonal brain pattern 36 with high morbidity and mortality. In a prospective study of 114 adult survivors of CA, myoclonus occurred in 35% of the patients, and MSE was diagnosed in 17% of these patients.…”

Section: Myoclonusmentioning

confidence: 99%

“…Seizures and status epilepticus are common following CA, 32,34,37,39 though there remains no consensus on the optimal timing for diagnosis and therapeutic management. The EEG monitoring and evaluation is of unclear benefit in terms of both prognostication and outcome, though continuing to be an active area of research.…”

Section: Seizures and Eegmentioning

confidence: 99%

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An Update in Postcardiac Arrest Management and Prognosis in the Era of Therapeutic Hypothermia

Cahill

Tirschwell

Khot

2013

The Neurohospitalist

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Prognostication of patients who remain comatose following successful resuscitation after cardiac arrest has long posed a challenge for the consulting neurologist. With increasing rates of early defibrillation, out-of-hospital cardiopulmonary resuscitation, and expanding use of therapeutic hypothermia, prognostication in hypoxic-ischemic encephalopathy has become an increasingly common consult for neurologists. Much of the data we previously relied upon for prognostication were taken from patients who were not treated with therapeutic hypothermia. In this review, we examine useful prognostic tools and markers, including the physical examination, evaluation of myoclonus, electroencephalogram monitoring, somatosensoryevoked potentials, biochemical markers of neuronal injury, and neuroimaging. Neurologists must avoid overly pessimistic prognostic statements regarding survival, awakening from coma, or future quality of life, as such statements may unduly influence decisions regarding the continuation of life-sustaining treatment. Conversely, continuation of aggressive medical management in a patient without any hope of awakening should also be avoided. Thus, an understanding of the utility and the limitations of these prognostic tools in the era of therapeutic hypothermia is essential.

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Section: Seizures and Eegmentioning

confidence: 96%

Section: Seizures and Eegmentioning

confidence: 96%

Section: Myoclonusmentioning

confidence: 99%

Section: Seizures and Eegmentioning

confidence: 99%

See 2 more Smart Citations

An Update in Postcardiac Arrest Management and Prognosis in the Era of Therapeutic Hypothermia

Cahill

Tirschwell

Khot

2013

The Neurohospitalist

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“…Less than half of those with return to spontaneous circulation survive to hospital discharge and 20%–30% of the survivors are neurologically devastated (Bisschops et al., 2011; Wijdicks et al., 2006). Seizures have been reported in 10%–12% of the survivors and have been shown to be an independent risk factor for mortality (Arnoldus & Lammers, 1995; Celesia, Grigg, & Ross, 1988; Fugate et al., 2010; Harper & Wilkes, 1991; Hui et al., 2005; Kawai, Thapalia, & Verma, 2011; Krumholz, Stern, & Weiss, 1988; Mani et al., 2012; Rabinstein & Wijdicks, 2012; Rossetti et al., 2007; Wijdicks, Parisi, & Sharbrough, 1994; Young, Jordan, & Doig, 1996). …”

Section: Introductionmentioning

confidence: 99%

Occurrence of overt seizures in comatose survivor patients treated with targeted temperature

et al. 2017

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BackgroundUnconscious patients after out‐of‐hospital cardiac arrest have a high risk of death. Therapeutic hypothermia is recommended by international resuscitation guidelines in order to attenuate secondary destructive physiological processes such as reperfusion injury, apoptosis, and cerebral edema. The target temperature to reach ranges between 32 and 34°C for at least 24 hr. Hypothermia can induce metabolic disturbances. There are some reports in the literature indicating the presence of seizures during targeted temperature management. On the other hand, postanoxic seizures are a sign of unfavorable neurological outcome. The purpose of this study was to evaluate the occurrence of overt seizures in comatose survivor patients treated with targeted temperature in respect to overt seizures in a normal temperature group of comatose patients.MethodsThis was a retrospective study of unconscious adults post cardiopulmonary resuscitation, hospitalized in the intensive care unit during the years 2008–2015. The patients were divided into two groups: those treated with hypothermia and those with normal body temperature. Both groups were evaluated for the appearance of overt seizures during their hospitalization which was the primary outcome of the study.ResultsThe data of 88 consecutive unconscious patients after out‐of‐hospital cardiac arrest were collected. Twenty‐six patients were treated with targeted temperature (32–34°C) and 62 patients with normal temperature. In the hypothermic group, 6 (23%) patients developed overt seizures during hospitalization compared to 11 (17%) in the normothermic group. The mortality rate was similar in both groups, 16 (61%) in the hypothermic group and 38 (61%) in the conservative group. According to the present study, overt seizures were more common in the group treated with hypothermia.

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Modeling Early-Onset Postischemic Seizures in Adult and Aging Mice

Zhang

Wang

2019

Basic Neurobiology Techniques

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The frequency and timing of epileptiform activity on continuous electroencephalogram in comatose post-cardiac arrest syndrome patients treated with therapeutic hypothermia

Cited by 137 publications

References 16 publications

An Update in Postcardiac Arrest Management and Prognosis in the Era of Therapeutic Hypothermia

An Update in Postcardiac Arrest Management and Prognosis in the Era of Therapeutic Hypothermia

Occurrence of overt seizures in comatose survivor patients treated with targeted temperature

Modeling Early-Onset Postischemic Seizures in Adult and Aging Mice

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