Time to epileptiform activity and EEG background recovery are independent predictors after cardiac arrest

Westhall, Erik; Rosén, Ingmar; Rundgren, Malin; Bro-Jeppesen, John; Kjærgaard, Jesper; Hassager, Christian; Lindehammar, Hans; Horn, Janneke; Ullén, Susann; Nielsen, Niklas; Friberg, Hans; Cronberg, Tobias

doi:10.1016/j.clinph.2018.05.016

Cited by 56 publications

(50 citation statements)

References 36 publications

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“…A progression of EEG background towards continuity and normal voltage in the early phase after arrest has been demonstrated in most patients with a final good outcome [73,147,148]. This is probably due to the general process of brain recovery after HIBI.…”

Section: Eeg Background Continuity and Voltagementioning

confidence: 90%

“…Conversely, FPR was very low in the first 24 h after ROSC, but increased later. In a study using continuous EEG [73], time to appearance of epileptiform activity was inversely correlated with the likelihood of poor outcome, while the opposite was observed with the time to recovery of a continuous normal voltage background. This can have implications in the timing for recording and assessment of these predictors in the clinical setting.…”

Section: Superimposed Dischargesmentioning

confidence: 97%

“…In two studies [65,73], lack of recovery of a continuous normal voltage background within 36 h from ROSC on amplitude-integrated EEG [65], or within 60 h on continuous EEG [73], predicted poor outcome with 0[0-5]% FPR (Table 35). The absence of EEG background reactivity assessed from 6 h to a median of 77 h after ROSC had 0% FPR in one small study [50].…”

Section: Eeg Background (Tablesmentioning

confidence: 99%

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Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review

et al. 2020

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Purpose: To assess the ability of clinical examination, blood biomarkers, electrophysiology, or neuroimaging assessed within 7 days from return of spontaneous circulation (ROSC) to predict poor neurological outcome, defined as death, vegetative state, or severe disability (CPC 3-5) at hospital discharge/1 month or later, in comatose adult survivors from cardiac arrest (CA). Methods: PubMed, EMBASE, Web of Science, and the Cochrane Database of Systematic Reviews (January 2013-April 2020) were searched. Sensitivity and false-positive rate (FPR) for each predictor were calculated. Due to heterogeneities in recording times, predictor thresholds, and definition of some predictors, meta-analysis was not performed. Results: Ninety-four studies (30,200 patients) were included. Bilaterally absent pupillary or corneal reflexes after day 4 from ROSC, high blood values of neuron-specific enolase from 24 h after ROSC, absent N20 waves of short-latency somatosensory-evoked potentials (SSEPs) or unequivocal seizures on electroencephalogram (EEG) from the day of ROSC, EEG background suppression or burst-suppression from 24 h after ROSC, diffuse cerebral oedema on brain CT from 2 h after ROSC, or reduced diffusion on brain MRI at 2-5 days after ROSC had 0% FPR for poor outcome in most studies. Risk of bias assessed using the QUIPS tool was high for all predictors. Conclusion: In comatose resuscitated patients, clinical, biochemical, neurophysiological, and radiological tests have a potential to predict poor neurological outcome with no false-positive predictions within the first week after CA. Guidelines should consider the methodological concerns and limited sensitivity for individual modalities. (PROSPERO CRD42019141169

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Section: Eeg Background Continuity and Voltagementioning

confidence: 90%

Section: Superimposed Dischargesmentioning

confidence: 97%

Section: Eeg Background (Tablesmentioning

confidence: 99%

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Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review

et al. 2020

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“…However, poor outcomes were observed in patients with a high index of regular periodic patterns, in contrast to findings observed in patients with individual epileptic discharges. 61 In 2016, Alvarez et al reported that background activity and sleep signs on EEG are more reliable predictors of good clinical outcomes after CPR than periodic or epileptic patterns. The regression model included EEG data, clinical information, and etiology.…”

Section: Periodic Discharges As a Predictor Of Outcomesmentioning

confidence: 99%

Clinical and Electrophysiological Differentiation between Periodical and Epileptic Discharges

Подлепич

Савин

2020

Journal of Neuroanaesthesiology and Critical Care

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Clinical differentiation between nonconvulsive status epilepticus (NCSE) and encephalopathy remains challenging. Some patients with encephalopathy exhibit periodic discharges on electroencephalography. In certain cases, however, it is rather difficult to differentiate between epileptic and periodic discharges. The lack of clear differentiation criteria makes it difficult to effectively analyze the studies in this field. In patients with refractory status epilepticus, the wrong diagnosis can lead to insufficient therapy, thereby increasing the frequency of convulsions and the likelihood of a poor outcome. Alternatively, aggressive therapy with antiepileptic drugs and anesthetic agents can aggravate neuronal damage and worsen encephalopathy. In this review, we aimed to determine whether clinical and instrumental methods can be used to differentiate between encephalopathy and epileptic states, to improve the selection of the appropriate treatment strategies. The review considers different approaches to diagnosing encephalopathy and seizures in critically ill patients. In spite of electroencephalography (EEG) still being the main method used to objectively identify brain dysfunction and diagnose epileptic discharges over the past 60 years, improvements in EEG techniques have been accompanied by increase in our understanding of the limitations of electrophysiological methods, leading to the use of additional tools for the differential diagnosis of seizures and encephalopathy. Current studies aim to develop multimodal approaches to the differential diagnosis of encephalopathy and NCSE. Modern reports describe clinical and instrumental approaches for accurately differentiating encephalopathy and epileptic conditions in patients treated in the intensive care unit based on clinical data, EEG, magnetic resonance imaging, positron emission tomography, biochemical analyses, and immune values.

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“…[9] The differential association of distinct patterns on the ictal-interictal spectrum, such as periodic or polyspike-wave discharges, with outcomes has not been rigorously explored. Most previous literature has aggregated any epileptiform discharges together as "malignant" (or epileptiform), [10][11][12][13][14][15] "highly-malignant," [12,13,16] or considered well-defined subtypes of epilepitiform activity such as generalized periodic discharges or burst suppression with identical bursts. [17][18][19] Guidelines describing the prognostic role of EEG have focused on characteristics of the EEG background, such as suppression, reactivity and continuity, and development of frank seizures.…”

Section: Introductionmentioning

confidence: 99%

Differential association of subtypes of epileptiform activity with outcome after cardiac arrest

et al. 2019

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Background: Epileptiform activity is common after cardiac arrest, although intensity of electroencephalographic (EEG) monitoring may affect detection rates. Prior work has grouped these patterns together as "malignant," without considering discrete subtypes. We describe the incidence of distinct patterns in the ictal interictal spectrum at two centers and their association with outcomes. Methods: We analyzed a retrospective cohort of comatose post-arrest patients admitted at two academic centers from January 2011 to October 2014. One center uses routine continuous EEG, the other acquires "spot" EEG at the treating physicians' discretion. We reviewed all available EEG data and classified epileptiform patterns. We abstracted antiepileptic drugs (AEDs) administrations from the electronic medical record. We compared apparent incidence of each pattern between centers, and compared outcomes (awakening from coma, survival to discharge, discharge modified Rankin Scale (mRS) 0-2) across EEG patterns and number of AEDs administered. Results: We included 818 patients. Routine continuous EEG was associated with a higher apparent incidence of polyspike burst-suppression (25% vs 13% P <0.001). Frequency of other epileptiform findings did not differ. Among patients with any epileptiform pattern, only 2/258 (1%, 95%CI 0-3%) were discharged with mRS 0-2, although 24/258 (9%, 95%CI 6-14%) awakened and 36/258 (14%, 95%CI 10-19%) survived. The proportions that awakened and survived decreased in a stepwise manner with progressively worse EEG patterns (range 38% to 2% and 32% to 7%, respectively). Among patients receiving ≥3 AEDs, only 5/80 (6%, 95%CI 2-14%) awakened and 1/80 (1%, 95%CI 0-7%) had a mRS 0-2.

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Time to epileptiform activity and EEG background recovery are independent predictors after cardiac arrest

Cited by 56 publications

References 36 publications

Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review

Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review

Clinical and Electrophysiological Differentiation between Periodical and Epileptic Discharges

Differential association of subtypes of epileptiform activity with outcome after cardiac arrest

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