• Stéphane Legriel, Fabrice Bruneel, Haouaria Sediri, Julia Hilly, Nathalie Abbosh, Matthieu Henry Lagarrigue, Gilles Troche, Pierre Guezennec, Fernando Pico, and Jean Pierre Bedos.
• Intensive Care Unit, Service de Réanimation medico-chirurgicale, Hôpital André Mignot, University Versailles-Saint-Quentin, 177 rue de Versailles, 78150 Le Chesnay Cedex, France. stlegriel@invivo.edu
• Neurocrit Care. 2009 Dec 1;11(3):338-44.

ObjectiveTo determine whether routine electroencephalography (EEG) detected electrical status epilepticus (ESE), masked by neuromuscular blockade, in comatose cardiac-arrest survivors receiving therapeutic hypothermia.DesignProspective 3-year study.SettingMedical ICU.PatientsFifty-one consecutive comatose cardiac-arrest patients treated between May 2005 and May 2008 using a standardized protocol of hypothermia with neuromuscular blockade.InterventionEEG was performed routinely as soon as possible after starting therapeutic hypothermia. EEG recordings were read by an independent neurophysiologist who was blinded to patient data.Measurements And Main ResultsMedian body temperature at EEG recording was 33.0°C (range 32.4-33.8). ESE was found on 5 (10%) of the 51 EEG recordings: three patients had continuous rhythmic generalized spikes and two patients had continuous rhythmic focal spike-waves. Of the 17 (33%) patients who were discharged alive, 8 (8/51, 16%) had a CPC score of 1, 4 (8%) of 2, and 5 (10%) of 3. All patients with ESE died during their ICU stay.ConclusionThese preliminary results indicate that postanoxic status epilepticus can be masked by neuromuscular blockade during our protocol of therapeutic hypothermia. Routine EEG monitoring might be helpful in cardiac-arrest survivors receiving therapeutic hypothermia. Further studies including continuous EEG monitoring are needed to determine whether early diagnosis and treatment of ESE during therapeutic hypothermia improves the outcome.

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