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

Beretta, S., Coppo, A., Bianchi, E., Zanchi, C., Carone, D., Stabile, A., et al. (2018). Neurologic outcome of postanoxic refractory status epilepticus after aggressive treatment. NEUROLOGY, 91(23), e2153-e2162 [10.1212/WNL.0000000000006615].

Neurologic outcome of postanoxic refractory status epilepticus after aggressive treatment

Coppo, Anna
Membro del Collaboration Group
;
Zanchi, Clara
Membro del Collaboration Group
;
Carone, Davide
Membro del Collaboration Group
;
Stabile, Andrea
Membro del Collaboration Group
;
Padovano, Giada
Membro del Collaboration Group
;
Sulmina, Endrit
Membro del Collaboration Group
;
Grassi, Alice
Membro del Collaboration Group
;
Foti, Giuseppe
Membro del Collaboration Group
;
Ferrarese, Carlo
Membro del Collaboration Group
;
Pesenti, Antonio;Beghi, Ettore;
2018

Abstract

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
No
Articolo in rivista - Articolo scientifico
Scientifica
status epilepticus
English
Beretta, S., Coppo, A., Bianchi, E., Zanchi, C., Carone, D., Stabile, A., et al. (2018). Neurologic outcome of postanoxic refractory status epilepticus after aggressive treatment. NEUROLOGY, 91(23), e2153-e2162 [10.1212/WNL.0000000000006615].
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
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/10281/226403
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