Lybeck Anna, Friberg Hans, Aneman Anders, Hassager Christian, Horn Janneke, Kjærgaard Jesper, Kuiper Michael, Nielsen Niklas, Ullén Susann, Wise Matthew P, Westhall Erik, Cronberg Tobias
Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Department of Anesthesia & Intensive Care, Lund 221 85, Sweden.
Intensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District, Elizabeth Street, Liverpool, Sydney, NSW 2170, Australia.
Resuscitation. 2017 May;114:146-151. doi: 10.1016/j.resuscitation.2017.01.017. Epub 2017 Feb 3.
Clinical seizures are common after cardiac arrest and predictive of a poor neurological outcome. Seizures may be myoclonic, tonic-clonic or a combination of seizure types. This study reports the incidence and prognostic significance of clinical seizures in the target temperature management (TTM) after cardiac arrest trial. Our hypotheses were that seizures are associated with a poor prognosis and that the incidence of seizures is not affected by the target temperature.
Post-hoc analysis of reported clinical seizures during day 1-7 in the TTM-trial including their treatment, EEG-findings, and long-term neurological outcome. The trial randomised 939 comatose survivors to TTM at 33°C or 36°C with strict criteria for withdrawal of life-sustaining therapies. Sensitivity, specificity and false positive rate for poor outcome were reported for different types of seizures.
Clinical seizures were registered in 268 patients (29%), similarly distributed in both intervention arms. Early and late seizures were equally predictive of poor outcome. Myoclonic seizures were the most common (240 patients, 26%) and the most predictive of a poor outcome (sensitivity 36.1%, false positive rate 4.3%). Two patients with status myoclonus regained consciousness, one with a good neurological outcome, generating a false positive rate of poor outcome of 0.2% (95%CI 0.0-1.0).
Clinical seizures are common after cardiac arrest and indicate poor outcome with limited specificity. Prolonged seizures are a very grave sign but occasional patients may have a good outcome. The level of the target temperature does not affect the prevalence or prognostic significance of seizures.
心脏骤停后临床癫痫发作很常见，且预示着神经功能预后不良。癫痫发作可能是肌阵挛性、强直阵挛性或多种发作类型的组合。本研究报告了心脏骤停后目标温度管理（TTM）试验中临床癫痫发作的发生率及预后意义。我们的假设是癫痫发作与预后不良相关，且癫痫发作的发生率不受目标温度的影响。
对TTM试验第1至7天报告的临床癫痫发作进行事后分析，包括其治疗、脑电图结果和长期神经功能预后。该试验将939名昏迷幸存者随机分为33°C或36°C的TTM组，并制定了严格的维持生命治疗撤药标准。报告了不同类型癫痫发作预后不良的敏感性、特异性和假阳性率。
268例患者（29%）记录到临床癫痫发作，在两个干预组中分布相似。早期和晚期癫痫发作对预后不良的预测作用相同。肌阵挛性癫痫发作最为常见（240例患者，26%），对预后不良的预测性最强（敏感性36.1%，假阳性率4.3%）。两名肌阵挛持续状态患者恢复意识，其中一名神经功能预后良好，导致预后不良的假阳性率为0.2%（95%CI 0.0 - 1.0）。
心脏骤停后临床癫痫发作很常见，提示预后不良，但特异性有限。长时间癫痫发作是一个非常严重的迹象，但偶尔有患者可能预后良好。目标温度水平不影响癫痫发作的发生率或预后意义。
