Time to epileptiform activity and EEG background recovery are independent predictors after cardiac arrest

TY - JOUR

T1 - Time to epileptiform activity and EEG background recovery are independent predictors after cardiac arrest

AU - Westhall, E.

AU - Rosén, I.

AU - Rundgren, M.

AU - Bro-Jeppesen, J.

AU - Kjaergaard, J.

AU - Hassager, C.

AU - Lindehammar, H.

AU - Horn, J.

AU - Ullén, S.

AU - Nielsen, N.

AU - Friberg, H.

AU - Cronberg, T.

PY - 2018

Y1 - 2018

N2 - Objective: Investigate the temporal development of EEG and prognosis. Methods: Prospective observational substudy of the Target Temperature Management trial. Six sites performed simplified continuous EEG-monitoring (cEEG) on comatose patients after cardiac arrest, blinded to treating physicians. We determined time-points of recovery of a normal-voltage continuous background activity and the appearance of an epileptiform EEG, defined as abundant epileptiform discharges, periodic/rhythmic discharges or electrographic seizure activity. Results: 134 patients were included, 65 had a good outcome. Early recovery of continuous background activity (within 24 h) occurred in 72 patients and predicted good outcome since 55 (76%) had good outcome, increasing the odds for a good outcome seven times compared to a late background recovery. Early appearance of an epileptiform EEG occurred in 38 patients and 34 (89%) had a poor outcome, increasing the odds for a poor outcome six times compared to a late debut. The time to background recovery and the time to epileptiform activity were highly associated with outcome and levels of neuron-specific enolase. Multiple regression analysis showed that both variables were independent predictors. Conclusions: Time to epileptiform activity and background recovery are independent prognostic indicators. Significance: Patients with early background recovery combined with late appearance of epileptiform activity may have a good outcome.

AB - Objective: Investigate the temporal development of EEG and prognosis. Methods: Prospective observational substudy of the Target Temperature Management trial. Six sites performed simplified continuous EEG-monitoring (cEEG) on comatose patients after cardiac arrest, blinded to treating physicians. We determined time-points of recovery of a normal-voltage continuous background activity and the appearance of an epileptiform EEG, defined as abundant epileptiform discharges, periodic/rhythmic discharges or electrographic seizure activity. Results: 134 patients were included, 65 had a good outcome. Early recovery of continuous background activity (within 24 h) occurred in 72 patients and predicted good outcome since 55 (76%) had good outcome, increasing the odds for a good outcome seven times compared to a late background recovery. Early appearance of an epileptiform EEG occurred in 38 patients and 34 (89%) had a poor outcome, increasing the odds for a poor outcome six times compared to a late debut. The time to background recovery and the time to epileptiform activity were highly associated with outcome and levels of neuron-specific enolase. Multiple regression analysis showed that both variables were independent predictors. Conclusions: Time to epileptiform activity and background recovery are independent prognostic indicators. Significance: Patients with early background recovery combined with late appearance of epileptiform activity may have a good outcome.

KW - Cardiac arrest

KW - Coma

KW - Continuous EEG monitoring

KW - EEG

KW - Prognosis

KW - Status epilepticus

U2 - 10.1016/j.clinph.2018.05.016

DO - 10.1016/j.clinph.2018.05.016

M3 - Journal article

C2 - 29933239

AN - SCOPUS:85048734370

SN - 1388-2457

VL - 129

SP - 1660

EP - 1668

JO - Clinical Neurophysiology

JF - Clinical Neurophysiology

IS - 8

ER -