title: Unstandardized treatment of electroencephalographic status epilepticus does not improve outcome of comatose patients after cardiac arrest.
abstract: OBJECTIVE
  Electroencephalographic status epilepticus occurs in 9-35% of comatose patients after cardiac arrest. Mortality is 90-100%. It is unclear whether (some) seizure patterns represent a condition in which anti-epileptic treatment may improve outcome, or severe ischemic damage, in which treatment is futile. We explored current treatment practice and its effect on patients' outcome.
  
  
  METHODS
  We retrospectively identified patients that were treated with anti-epileptic drugs from our prospective cohort study on the value of continuous electroencephalography (EEG) in comatose patients after cardiac arrest. Outcome at 6 months was dichotomized between "good" [cerebral performance category (CPC) 1 or 2] and "poor" (CPC 3, 4, or 5). EEG analyses were done at 24 h after cardiac arrest and during anti-epileptic treatment. Unequivocal seizures and generalized periodic discharges during more than 30 min were classified as status epilepticus.
  
  
  RESULTS
  Thirty-one (22%) out of 139 patients were treated with anti-epileptic drugs (phenytoin, levetiracetam, valproate, clonazepam, propofol, midazolam), of whom 24 had status epilepticus. Dosages were moderate, barbiturates were not used, medication induced burst-suppression not achieved, and treatment improved electroencephalographic status epilepticus patterns temporarily (<6 h). Twenty-three patients treated for status epilepticus (96%) died. In patients with status epilepticus at 24 h, there was no difference in outcome between those treated with and without anti-epileptic drugs.
  
  
  CONCLUSIONS
  In comatose patients after cardiac arrest complicated by electroencephalographic status epilepticus, current practice includes unstandardized, moderate treatment with anti-epileptic drugs. Although widely used, this does probably not improve patients' outcome. A randomized controlled trial to estimate the effect of standardized, aggressive treatment, directed at complete suppression of epileptiform activity during at least 24 h, is needed and in preparation.
authors.affiliation: Clinical Neurophysiology, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente , Enschede , Netherlands ; Department of Neurology, Rijnstate Hospital , Arnhem , Netherlands.
authors.forename: Jeannette
authors.initials: J
authors.lastname: Hofmeijer
authors.affiliation: Clinical Neurophysiology, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente , Enschede , Netherlands ; Department of Clinical Neurophysiology, Medisch Spectrum Twente , Enschede , Netherlands.
authors.forename: Marleen C
authors.initials: MC
authors.lastname: Tjepkema-Cloostermans
authors.affiliation: Department of Intensive Care, Rijnstate Hospital , Arnhem , Netherlands.
authors.forename: Michiel J
authors.initials: MJ
authors.lastname: Blans
authors.affiliation: Department of Intensive Care, Medisch Spectrum Twente , Enschede , Netherlands.
authors.forename: Albertus
authors.initials: A
authors.lastname: Beishuizen
authors.affiliation: Clinical Neurophysiology, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente , Enschede , Netherlands ; Department of Clinical Neurophysiology, Medisch Spectrum Twente , Enschede , Netherlands.
authors.forename: Michel J A M
authors.initials: MJ
authors.lastname: van Putten
keywords: anti-epileptic drugs; cardiac arrest; continuous EEG; epileptic seizures; post-anoxic coma; prognosis; status epilepticus
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