title: Early EEG monitoring for detecting postanoxic status epilepticus during therapeutic hypothermia: a pilot study.
abstract: OBJECTIVE
  To determine whether routine electroencephalography (EEG) detected electrical status epilepticus (ESE), masked by neuromuscular blockade, in comatose cardiac-arrest survivors receiving therapeutic hypothermia.
  
  
  METHODS
  Prospective 3-year study.
  
  
  METHODS
  Medical ICU.
  
  
  METHODS
  Fifty-one consecutive comatose cardiac-arrest patients treated between May 2005 and May 2008 using a standardized protocol of hypothermia with neuromuscular blockade.
  
  
  METHODS
  EEG was performed routinely as soon as possible after starting therapeutic hypothermia. EEG recordings were read by an independent neurophysiologist who was blinded to patient data.
  
  
  RESULTS
  Median body temperature at EEG recording was 33.0°C (range 32.4-33.8). ESE was found on 5 (10%) of the 51 EEG recordings: three patients had continuous rhythmic generalized spikes and two patients had continuous rhythmic focal spike-waves. Of the 17 (33%) patients who were discharged alive, 8 (8/51, 16%) had a CPC score of 1, 4 (8%) of 2, and 5 (10%) of 3. All patients with ESE died during their ICU stay.
  
  
  CONCLUSIONS
  These preliminary results indicate that postanoxic status epilepticus can be masked by neuromuscular blockade during our protocol of therapeutic hypothermia. Routine EEG monitoring might be helpful in cardiac-arrest survivors receiving therapeutic hypothermia. Further studies including continuous EEG monitoring are needed to determine whether early diagnosis and treatment of ESE during therapeutic hypothermia improves the outcome.
authors: Intensive Care Unit, Service de Réanimation medico-chirurgicale, Hôpital André Mignot, University Versailles-Saint-Quentin, 177 rue de Versailles, 78150 Le Chesnay Cedex, France. stlegriel@invivo.edu
authors: Stéphane
authors: S
authors: Legriel
authors: Fabrice
authors: F
authors: Bruneel
authors: Haouaria
authors: H
authors: Sediri
authors: Julia
authors: J
authors: Hilly
authors: Nathalie
authors: N
authors: Abbosh
authors: Matthieu Henry
authors: MH
authors: Lagarrigue
authors: Gilles
authors: G
authors: Troche
authors: Pierre
authors: P
authors: Guezennec
authors: Fernando
authors: F
authors: Pico
authors: Jean Pierre
authors: JP
authors: Bedos
mesh_terms: D000328:Adult; D000368:Aged; D003422:Critical Care / Q000379:methods; D042241:Early Diagnosis; D004569:Electroencephalography; D005260:Female; D006323:Heart Arrest / Q000150:complications; D006801:Humans; D007036:Hypothermia, Induced; D002534:Hypoxia, Brain / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D009466:Neuromuscular Blocking Agents / Q000627:therapeutic use; D010865:Pilot Projects; D011446:Prospective Studies; D013226:Status Epilepticus / Q000175:diagnosis* / Q000209:etiology*
chemical_list: D009466:Neuromuscular Blocking Agents