Postanoxic status epilepticus can be identified and treatment guided successfully by continuous electroencephalography.

Abstract

Prognostication after cardiac arrest and therapeutic hypothermia is challenging. Recent data indicate that a subgroup of patients with postanoxic status epilepticus may recover. We describe a case of postanoxic status epilepticus with good outcome where a multimodal prognostic strategy motivated active and prolonged treatment. Our patient was a 61-year-old woman resuscitated from out-of-hospital cardiac arrest, treated with hypothermia, and monitored with continuous electroencephalography (EEG). Shortly after rewarming, 44 hours after cardiac arrest, electrographic status epilepticus developed and was manifested clinically by myoclonic seizures several hours later. Treatment was guided by continuous simplified EEG monitoring. Conventional antiepileptics were ineffective, and prolonged sedation was necessary to prevent recurrence. Magnetic resonance imaging, somatosensory evoked potentials, and repeated measurements of neuron-specific enolase were unremarkable and did not indicate a poor prognosis. Rather, the EEG characteristics suggested a potential for recovery, and therefore the patient was actively treated until recovery 3 weeks later. At follow-up after 4.5 months, she had only minor neurological sequels. We conclude that a favorable neurological outcome is possible despite prolonged postanoxic status epilepticus. A multimodal strategy for prognostication may help identify treatable cases. Continuous EEG monitoring is an important tool to detect and guide treatment of postanoxic status epilepticus.