Treatment of electroencephalographic status epilepticus after cardiopulmonary resuscitation (TELSTAR): study protocol for a randomized controlled trial.
BACKGROUND
Electroencephalographic (EEG) status epilepticus is described in 10 to 35% of patients with postanoxic encephalopathy after successful cardiopulmonary resuscitation and is associated with case fatality rates of 90 to 100%. It is unclear whether these EEG patterns represent a condition to be treated with anticonvulsants to improve outcome, or an expression of severe ischemic damage, in which treatment is futile.


METHODS
TELSTAR is a multicenter clinical trial with two parallel groups, randomized treatment allocation, open label treatment, and blinded endpoint evaluation (PROBE design). We aim to enroll 172 adult patients with postanoxic encephalopathy and electroencephalographic status epilepticus after successful cardiopulmonary resuscitation, admitted to the ICU, in whom continuous EEG monitoring is started within 24 hours after admission. Patients are randomly assigned to either medical treatment to suppress all electrographic seizure activity, or no treatment of electroencephalographic status epilepticus. Antiepileptic treatment is based on guidelines for treatment of overt status epilepticus and is started within 3 hours after the diagnosis. If status epilepticus returns during tapering of sedative medication after suppression of all epileptiform activity for 2 × 24 hours, it will be considered refractory. The primary outcome measure is neurological outcome defined as the Cerebral Performance Category (CPC) score at 3 months, dichotomized into 'good' (CPC 1 to 2 = no or moderate neurological disability) and 'poor' (CPC 3 to 5 = severe disability, coma, or death). Secondary outcome measures include mortality and, for patients surviving up to 12 months, cognitive functioning, health related quality of life, and depression.


BACKGROUND
Clinicaltrials.gov; NCT02056236. Date of registration: 4 February 2014.
Clinical Neurophysiology group, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Hallenweg 15, 7522NB Enschede, The Netherlands. b.j.ruijter@utwente.nl.
Barry J
BJ
Ruijter
Michel J A M
MJ
van Putten
Janneke
J
Horn
Michiel J
MJ
Blans
Albertus
A
Beishuizen
Anne-Fleur
AF
van Rootselaar
Jeannette
J
Hofmeijer
D000927:Anticonvulsants / Q000627:therapeutic use*; D058256:Brain Waves / Q000187:drug effects*; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects* / Q000401:mortality; D002985:Clinical Protocols; D003071:Cognition; D003863:Depression / Q000209:etiology / Q000523:psychology; D004185:Disability Evaluation; D004569:Electroencephalography; D006801:Humans; D007362:Intensive Care Units; D009426:Netherlands; D009460:Neurologic Examination; D011237:Predictive Value of Tests; D011788:Quality of Life; D012107:Research Design; D013226:Status Epilepticus / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome
D000927:Anticonvulsants