Department of Neurology, Penn Epilepsy Center, University of Pennsylvania, United States.
Resuscitation. 2012 Jul;83(7):840-7. doi: 10.1016/j.resuscitation.2012.02.015. Epub 2012 Feb 23.
The incidence and timing of electrographic seizures and epileptiform activity in comatose, adult, post-cardiac arrest syndrome (PCAS) patients treated with therapeutic hypothermia (TH) have not been extensively investigated. We hypothesized that onset most frequently occurs within the first 24 h post-arrest and is associated with poor neurologic outcome.
Single-center, retrospective analysis of a cohort of 38 comatose PCAS patients treated with TH and continuous-EEG-monitoring (cEEG), initiated as soon as possible after ICU admission. All raw cEEG waveform records were cleared of annotations and clinical information and classified by two fellowship-trained electroencephalographers.
Twenty-three percent (9/38) of patients had electrographic seizures (median onset 19 h post-arrest); 5/9 (56%) had seizure-onset prior to rewarming; 7/9 (78%) had status epilepticus. Forty-five percent (17/38) had evidence of epileptiform activity (electrographic seizures or interictal epileptiform discharges), typically occurring during first 24 h post-arrest. Interictal epileptiform activity was highly associated with later detection of electrographic seizures (6/14, 43%, p=0.001). Ninety-four percent (16/17) of patients with epileptiform activity had poor neurologic outcome or death at discharge (Cerebral Performance Category scale 3-5; p=0.002) as did all (9/9) patients with electrographic seizures (p=0.034).
Electrographic seizures and epileptiform activity are common cEEG findings in comatose, PCAS patients treated with TH. In this preliminary study, most seizures were status epilepticus, had onset prior to rewarming, evolved from prior interictal epileptiform activity, and were associated with short-term mortality and poor neurologic outcome. Larger, prospective studies are needed to further characterize seizure activity in comatose post-arrest patients.
接受治疗性低温（TH）治疗的昏迷、成年、心搏骤停后综合征（PCAS）患者的电发作和癫痫样活动的发生率和时间尚未得到广泛研究。我们假设发作最常发生在心脏骤停后 24 小时内，与不良神经结局相关。
对 38 例接受 TH 和连续脑电图监测（cEEG）治疗的昏迷 PCAS 患者进行单中心回顾性分析，这些患者在 ICU 入院后尽快开始进行治疗。所有原始 cEEG 波形记录均清除注释和临床信息，并由两名接受过专科培训的脑电图医师进行分类。
23%（9/38）的患者出现电发作（中位发作时间为心脏骤停后 19 小时）；5/9（56%）的患者在复温前出现发作起始；7/9（78%）的患者出现癫痫持续状态。45%（17/38）有癫痫样活动的证据（电发作或发作间期癫痫样放电），通常发生在心脏骤停后 24 小时内。发作间期癫痫样活动与随后检测到电发作高度相关（6/14，43%，p=0.001）。有癫痫样活动的 17 例患者中有 16 例（94%）在出院时神经功能结局不良或死亡（脑功能表现分类 3-5 级；p=0.002），9 例电发作患者均如此（p=0.034）。
在接受 TH 治疗的昏迷、PCAS 患者中，脑电图上出现电发作和癫痫样活动很常见。在这项初步研究中，大多数发作是癫痫持续状态，在复温前发生，由先前的发作间期癫痫样活动演变而来，与短期死亡率和不良神经结局相关。需要更大规模的前瞻性研究来进一步描述昏迷后心脏骤停患者的发作活动。
