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Time to epileptiform activity and EEG background recovery are independent predictors after cardiac arrest

Westhall, E. LU ; Rosén, I. LU ; Rundgren, M. LU ; Bro-Jeppesen, J. ; Kjaergaard, J. ; Hassager, C. ; Lindehammar, H. ; Horn, J. ; Ullén, S. LU and Nielsen, N. LU , et al. (2018) In Clinical Neurophysiology 129(8). p.1660-1668
Abstract

Objective: Investigate the temporal development of EEG and prognosis. Methods: Prospective observational substudy of the Target Temperature Management trial. Six sites performed simplified continuous EEG-monitoring (cEEG) on comatose patients after cardiac arrest, blinded to treating physicians. We determined time-points of recovery of a normal-voltage continuous background activity and the appearance of an epileptiform EEG, defined as abundant epileptiform discharges, periodic/rhythmic discharges or electrographic seizure activity. Results: 134 patients were included, 65 had a good outcome. Early recovery of continuous background activity (within 24 h) occurred in 72 patients and predicted good outcome since 55 (76%) had good outcome,... (More)

Objective: Investigate the temporal development of EEG and prognosis. Methods: Prospective observational substudy of the Target Temperature Management trial. Six sites performed simplified continuous EEG-monitoring (cEEG) on comatose patients after cardiac arrest, blinded to treating physicians. We determined time-points of recovery of a normal-voltage continuous background activity and the appearance of an epileptiform EEG, defined as abundant epileptiform discharges, periodic/rhythmic discharges or electrographic seizure activity. Results: 134 patients were included, 65 had a good outcome. Early recovery of continuous background activity (within 24 h) occurred in 72 patients and predicted good outcome since 55 (76%) had good outcome, increasing the odds for a good outcome seven times compared to a late background recovery. Early appearance of an epileptiform EEG occurred in 38 patients and 34 (89%) had a poor outcome, increasing the odds for a poor outcome six times compared to a late debut. The time to background recovery and the time to epileptiform activity were highly associated with outcome and levels of neuron-specific enolase. Multiple regression analysis showed that both variables were independent predictors. Conclusions: Time to epileptiform activity and background recovery are independent prognostic indicators. Significance: Patients with early background recovery combined with late appearance of epileptiform activity may have a good outcome.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Cardiac arrest, Coma, Continuous EEG monitoring, EEG, Prognosis, Status epilepticus
in
Clinical Neurophysiology
volume
129
issue
8
pages
9 pages
publisher
Elsevier
external identifiers
  • scopus:85048734370
  • pmid:29933239
ISSN
1388-2457
DOI
10.1016/j.clinph.2018.05.016
language
English
LU publication?
yes
id
d8633dff-359c-4f2d-a9e7-88fc05a543eb
date added to LUP
2018-06-27 16:15:23
date last changed
2024-03-01 21:18:12
@article{d8633dff-359c-4f2d-a9e7-88fc05a543eb,
  abstract     = {{<p>Objective: Investigate the temporal development of EEG and prognosis. Methods: Prospective observational substudy of the Target Temperature Management trial. Six sites performed simplified continuous EEG-monitoring (cEEG) on comatose patients after cardiac arrest, blinded to treating physicians. We determined time-points of recovery of a normal-voltage continuous background activity and the appearance of an epileptiform EEG, defined as abundant epileptiform discharges, periodic/rhythmic discharges or electrographic seizure activity. Results: 134 patients were included, 65 had a good outcome. Early recovery of continuous background activity (within 24 h) occurred in 72 patients and predicted good outcome since 55 (76%) had good outcome, increasing the odds for a good outcome seven times compared to a late background recovery. Early appearance of an epileptiform EEG occurred in 38 patients and 34 (89%) had a poor outcome, increasing the odds for a poor outcome six times compared to a late debut. The time to background recovery and the time to epileptiform activity were highly associated with outcome and levels of neuron-specific enolase. Multiple regression analysis showed that both variables were independent predictors. Conclusions: Time to epileptiform activity and background recovery are independent prognostic indicators. Significance: Patients with early background recovery combined with late appearance of epileptiform activity may have a good outcome.</p>}},
  author       = {{Westhall, E. and Rosén, I. and Rundgren, M. and Bro-Jeppesen, J. and Kjaergaard, J. and Hassager, C. and Lindehammar, H. and Horn, J. and Ullén, S. and Nielsen, N. and Friberg, H. and Cronberg, T.}},
  issn         = {{1388-2457}},
  keywords     = {{Cardiac arrest; Coma; Continuous EEG monitoring; EEG; Prognosis; Status epilepticus}},
  language     = {{eng}},
  month        = {{08}},
  number       = {{8}},
  pages        = {{1660--1668}},
  publisher    = {{Elsevier}},
  series       = {{Clinical Neurophysiology}},
  title        = {{Time to epileptiform activity and EEG background recovery are independent predictors after cardiac arrest}},
  url          = {{http://dx.doi.org/10.1016/j.clinph.2018.05.016}},
  doi          = {{10.1016/j.clinph.2018.05.016}},
  volume       = {{129}},
  year         = {{2018}},
}