Neurologic outcome of postanoxic refractory status epilepticus after aggressive treatment. Beretta S, Coppo A, Bianchi E, et al. Neurology. 2018;91(23):e2153-e2162. doi:10.1212/WNL.0000000000006615. Epub October 31, 2018. 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 electroencephalogram (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 The RSE occurred in 36 (21.7%) patients and was treated with an aggressive standardized protocol as long as multimodal prognostic indicators were not unfavorable. The RSE started 3 ± 2.3 days after cardiac arrest and lasted 4.7 ± 4.3 days. A benign EEG pattern was recorded in 76 (45.8%) patients, a periodic pattern (GPDs) was seen in 13 (7.8%) patients, and a malignant nonepileptiform EEG pattern was recorded in 41 (24.7%) patients. 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.

中文翻译：

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难治性癫痫持续状态的心脏骤停患者的好结果：积极治疗或脑电分类的结果。

积极治疗后缺氧后难治性癫痫持续状态的神经系统结果。Beretta S，Coppo A，Bianchi E等。神经病学。2018; 91（23）：e2153-e2162。doi：10.1212 / WNL.0000000000006615。Epub 2018年10月31日。目的研究与使用其他脑电图（EEG）模式的患者相比，使用抗癫痫药和麻醉剂进行标准化攻击性协议治疗的难治性癫痫持续状态（RSE）心脏骤停患者的神经系统结局。方法在前瞻性队列研究中，根据4种独立的EEG模式（良性，RSE，广义周期性放电[GPD]，恶性非脊突状）和多模式预后指标对166例连续的昏迷性心脏骤停患者进行分层。主要结局为6个月时的生存率和脑功能类别（CPC）。结果RSE发生在36名（21.7％）患者中，并且只要多模式预后指标并不不利，就可以通过积极的标准化方案进行治疗。RSE在心脏骤停后3±2.3天开始，持续4.7±4.3天。在76例（45.8％）患者中记录到良性EEG模式，在13例（7.8％）患者中观察到周期性模式（GPDs），在41例（24.7％）患者中记录到恶性非脂头状EEG模式。4种脑电图模式与不同的预后指标（低血流时间，临床运动性癫痫发作，N20反应，神经元特异性烯醇化酶，神经影像学）高度相关。良性脑电图在6个月时的存活率和良好的神经系统预后（CPC 1或2）分别为72.4％和71.1％，RSE为54.3％和44.4％，GPD为15.4％和0％，恶性非癫痫样为2.4％和0％脑电图分别。