Department of Neurology.
Epileptic Disord. 2012 Sep;14(3):340-4. doi: 10.1684/epd.2012.0519.
Prognostication following anoxic coma relies on clinical assessment and is assisted by neurophysiology. A non-evolving EEG spike burst/isoelectric suppression pattern after the first 24 hours almost invariably indicates poor outcome, while an evolving pattern implies nonconvulsive status epilepticus (NCSE) that may "hide" surviving brain activity and is amenable to treatment.
We present the case of a 53-year-old woman who had a witnessed out-of-hospital ventricular fibrillation cardiac arrest, was resuscitated by paramedics, but remained comatose. An EEG, performed 36 hours post-insult, showed an unremitting, non-evolving, unresponsive 2-6 Hz high-voltage spike burst/isoelectric suppression pattern, which remained unchanged at 96 hours post-insult, following therapeutic hypothermia. During this period, she was completely off sedation and taking triple antiepileptic treatment, without systemic confounding disorders. Although the initial pattern was indicative of poor neurological outcome, she eventually made meaningful functional recovery; the last EEG showed satisfactory background rhythms and stimulus-induced epileptiform discharges without seizures.
In post-anoxic coma, non-evolving >2 Hz spike burst/isoelectric suppression pattern may still reflect NCSE and therefore should be considered in the diagnostic EEG criteria for NCSE. Such borderline patterns should not dissuade physicians from intensifying treatment until more confident prognostication can be made.
在缺氧性昏迷后进行预后评估依赖于临床评估，并辅助神经生理学。在最初 24 小时后出现非进展性 EEG 尖波爆发/等电抑制模式几乎总是表明预后不良，而进展性模式则提示非惊厥性癫痫持续状态（NCSE），可能“隐藏”存活的脑活动，并可进行治疗。
我们报告了一例 53 岁女性的病例，她经历了院外室颤性心脏骤停，被急救人员复苏，但仍处于昏迷状态。在发病后 36 小时进行的 EEG 显示，一种持续存在、非进展性、无反应的 2-6 Hz 高电压尖波爆发/等电抑制模式，在接受治疗性低温后，在发病后 96 小时仍未改变。在此期间，她完全停止镇静，并接受三联抗癫痫治疗，没有全身性混淆障碍。尽管初始模式表明神经功能预后不良，但她最终实现了有意义的功能恢复；最后一次 EEG 显示背景节律令人满意，刺激诱发癫痫样放电而无癫痫发作。
在缺氧性昏迷后，非进展性 >2 Hz 尖波爆发/等电抑制模式仍可能反映 NCSE，因此应在 NCSE 的诊断性 EEG 标准中考虑。这种边界模式不应劝阻医生停止强化治疗，直到可以做出更有信心的预后判断。
