Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society
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J Clin Neurophysiol · Dec 2015
ReviewShould Postanoxic Status Epilepticus Be Treated Agressively? Yes!
Cardiac arrest is common and has a high mortality rate. For resuscitated patients, the development of hypoxic-ischemic brain injury is the major culprit. ⋯ Postanoxic status epilepticus is not an established criterion of a poor neurologic prognosis, and a good outcome is possible. Patients with postanoxic status epilepticus should therefore be actively treated with prolonged intensive care including antiepileptic and sedative agents to suppress seizure activity, if reliable indicators of a poor prognosis are absent.
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J Clin Neurophysiol · Dec 2015
ReviewEEG as an Indicator of Cerebral Functioning in Postanoxic Coma.
Postanoxic coma after cardiac arrest is one of the most serious acute cerebral conditions and a frequent cause of admission to critical care units. Given substantial improvement of outcome over the recent years, a reliable and timely assessment of clinical evolution and prognosis is essential in this context, but may be challenging. In addition to the classic neurologic examination, EEG is increasingly emerging as an important tool to assess cerebral functions noninvasively. ⋯ Here, the most frequently encountered EEG patterns in postanoxic coma are summarized and their relations with outcome prediction are discussed. This article also addresses the influence of targeted temperature management on brain signals and the implication of the evolution of EEG patterns over time. Finally, the article ends with a view of the future prospects for EEG in postanoxic management and prognostication.
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J Clin Neurophysiol · Dec 2015
ReviewACNS Critical Care EEG Terminology: Value, Limitations, and Perspectives.
The interpretation of the EEG in the critically ill remains a clinical challenge. Because continuous EEG monitoring plays an increasing role in patients' care, it is important that research efforts investigate the clinical significance of periodic and rhythmic discharges and of background abnormalities. ⋯ Studies using the terminology have already started to define the clinical and prognostic values of several known or newly described EEG patterns. Yet, as the field of critical care EEG evolves, improvements will be required to further enhance the clarity of the terminology and incorporate new findings from ongoing research.
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J Clin Neurophysiol · Dec 2015
ReviewShould Postanoxic Status Epilepticus be Treated Aggressively?-No!
Electrographic status epilepticus and myoclonus represent frequent findings in patients surviving cardiac arrest; both features have been related to poor clinical outcome. Recent data have outlined that status epilepticus appearing during therapeutic hypothermia and sedation is practically and invariably related to a fatal issue, as opposed to some patients presenting status epilepticus and/or myoclonus after return to normothermic conditions. Although it seems reasonable to give a chance of awakening to the latter patients by administering consequent antiepileptic treatment, especially if other favorable prognostic markers are observed, an aggressive treatment of status epilepticus arising during hypothermia seems futile in view of the existing evidence.