Neurologic outcome of postanoxic refractory status epilepticus after aggressive treatment

被引:58
作者
Beretta, Simone [1 ]
Coppo, Anna [2 ,3 ]
Bianchi, Elisa [4 ]
Zanchi, Clara [1 ]
Carone, Davide [1 ]
Stabile, Andrea [1 ]
Padovano, Giada [1 ]
Sulmina, Endrit [2 ,3 ]
Grassi, Alice [2 ,3 ]
Bogliun, Graziella [1 ]
Foti, Giuseppe [2 ,3 ]
Ferrarese, Carlo [1 ]
Pesenti, Antonio [5 ]
Beghi, Ettore [4 ]
Avalli, Leonello [2 ,3 ]
机构
[1] Univ Milano Bicocca, San Gerardo Hosp ASST Monza, Epilepsy Ctr, Monza, Italy
[2] Univ Milano Bicocca, San Gerardo Hosp ASST Monza, Dept Neurol, Monza, Italy
[3] Univ Milano Bicocca, San Gerardo Hosp ASST Monza, Dept Intens Care, Monza, Italy
[4] Mario Negri Inst Pharmacol Res, Dept Neurosci, Milan, Italy
[5] IRCCS Osped Maggiore Policlin, Crit Care & Emergency, Dept Anesthesia, Milan, Italy
关键词
TARGETED TEMPERATURE MANAGEMENT; NONCONVULSIVE STATUS EPILEPTICUS; HOSPITAL CARDIAC-ARREST; EEG TERMINOLOGY; PROGNOSTICATION; RESUSCITATION; SURVIVAL; WITHDRAWAL; FREQUENCY; PROTOCOL;
D O I
10.1212/WNL.0000000000006615
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Objective To 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. Methods In 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. Results RSE 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. Conclusions Aggressive and prolonged treatment of RSE may be justified in patients with cardiac arrest with favorable multimodal prognostic indicators.
引用
收藏
页码:E2153 / E2162
页数:10
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