Neuro-Intensive Care Unit, Department of Intensive Care, University Hospital of Geneva, Geneva, Switzerland.
EEG and Epilepsy Unit, Neurology Unit, Department of Clinical Neurosciences and Faculty of Medicine of Geneva, University Hospital of Geneva, Geneva, Switzerland.
J Neurol. 2023 Jan;270(1):130-138. doi: 10.1007/s00415-022-11368-5. Epub 2022 Sep 8.
Seizures and status epilepticus (SE) are detected in almost a third of the comatose cardiac arrest survivors. As the literature is quite exhaustive regarding SE with motor symptoms in those patients, little is known about nonconvulsive SE (NCSE). Our aim was to compile the evidence from the literature of the frequency and outcome of NCSE in adult patients remaining in coma after resuscitation.
The medical search PubMed was screened for most relevant articles reporting the emergence and outcome of NCSE in comatose post-resuscitated adult patients.
We identified 11 cohort studies (four prospective observational, seven retrospective) including 1092 patients with SE in 29-96% and NCSE reported in 1-20%. EEG evaluation started at a median of 9.5 h (range 7.5-14.8) after cardiac arrest, during sedation and targeted temperature management (TTM). Favorable outcome after NCSE occurred in 24.5%. We found no study reporting EEG to detect or exclude NCSE in patients remaining in coma prior to the initiation of TTM and without sedation withing the first hours after ROSC.
Studies on NCSE after ROSC are scarce and unsystematic, reporting favorable outcome in every fourth patient experiencing NCSE after ROSC. This suggests that NCSE is often overlooked and outcome after NCSE is not always poor. The low data quality does not allow firm conclusions regarding the effects of NCSE on outcome calling for further investigation. In the meantime, clinicians should avoid equating NCSE after ROSC with poor prognosis.
在近三分之一的心脏骤停幸存者中会检测到癫痫发作和癫痫持续状态（SE）。由于文献中对于伴有运动症状的 SE 有详尽的描述，因此对于非惊厥性 SE（NCSE）的了解较少。我们的目的是整理文献中关于复苏后昏迷的成年患者中 NCSE 的频率和结局的证据。
对 PubMed 医学文献进行筛选，以获取报告昏迷后复苏的成年患者中 NCSE 出现和结局的最相关文章。
我们确定了 11 项队列研究（4 项前瞻性观察性研究，7 项回顾性研究），包括 1092 例 SE 患者，SE 发生率为 29%-96%，NCSE 报告发生率为 1%-20%。EEG 评估在心脏骤停后中位数 9.5 小时（范围 7.5-14.8）开始，在镇静和目标温度管理（TTM）期间进行。NCSE 后的良好结局发生率为 24.5%。我们没有发现任何研究报告在 TTM 开始前和心脏骤停后最初几小时内无镇静且没有 NCSE 的患者中进行 EEG 以检测或排除 NCSE。
关于 ROSC 后 NCSE 的研究很少且无系统，报告称每 4 例 ROSC 后发生 NCSE 的患者中就有 1 例结局良好。这表明 NCSE 经常被忽视，并且 NCSE 后的结局并不总是很差。低数据质量不允许对 NCSE 对结局的影响做出明确的结论，需要进一步的研究。同时，临床医生不应将 ROSC 后 NCSE 等同于预后不良。
