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Abstract
Objective After cardiac arrest (CA), epileptiform EEG, occurring in about 1/3 of patients, often but not invariably heralds poor prognosis. We tested the hypothesis that a combination of specific EEG features identifies patients who may regain consciousness despite early epileptiform patterns.
Methods We retrospectively analyzed a registry of comatose patients post-CA (2 Swiss centers), including those with epileptiform EEG. Background and epileptiform features in EEGs 12–36 hours or 36–72 hours from CA were scored according to the American Clinical Neurophysiology Society nomenclature. Best Cerebral Performance Category (CPC) score within 3 months (CPC 1–3 vs 4–5) was the primary outcome. Significant EEG variables were combined in a score assessed with receiver operating characteristic curves, and independently validated in a US cohort; its correlation with serum neuron-specific enolase (NSE) was also tested.
Results Of 488 patients, 107 (21.9%) had epileptiform EEG <72 hours; 18 (17%) reached CPC 1–3. EEG 12–36 hours background continuity ≥50%, absence of epileptiform abnormalities (p < 0.00001 each), 12–36 and 36–72 hours reactivity (p < 0.0001 each), 36–72 hours normal background amplitude (p = 0.0004), and stimulus-induced discharges (p = 0.0001) correlated with favorable outcome. The combined 6-point score cutoff ≥2 was 100% sensitive (95% confidence interval [CI], 78%–100%) and 70% specific (95% CI, 59%–80%) for CPC 1–3 (area under the curve [AUC], 0.98; 95% CI, 0.94–1.00). Increasing score correlated with NSE (ρ = −0.46, p = 0.0001). In the validation cohort (41 patients), the score was 100% sensitive (95% CI, 60%–100%) and 88% specific (95% CI, 73%–97%) for CPC 1–3 (AUC, 0.96; 95% CI, 0.91–1.00).
Conclusion Prognostic value of early epileptiform EEG after CA can be estimated combining timing, continuity, reactivity, and amplitude features in a score that correlates with neuronal damage.
Glossary
- ACNS=
- American Clinical Neurophysiology Society;
- AED=
- antiepileptic drug;
- AUC=
- area under the curve;
- CA=
- cardiac arrest;
- cEEG=
- continuous EEG;
- CHUV=
- Centre Hospitalier Universitaire Vaudois;
- CI=
- confidence interval;
- CPC=
- Cerebral Performance Category;
- GPD=
- generalized periodic discharge;
- ICU=
- intensive care unit;
- NSE=
- neuron-specific enolase;
- PD=
- periodic discharge;
- ROC=
- receiver operating characteristic;
- ROSC=
- return of spontaneous circulation;
- SE=
- status epilepticus;
- SIRPID=
- stimulus-induced rhythmic, periodic, or ictal discharge;
- SSEP=
- somatosensory evoked potential;
- SW=
- spike and wave;
- TTM=
- targeted temperature management;
- WLST=
- withdrawal of life-sustaining therapy
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Editorial, page 685
CME Course: NPub.org/cmelist
- Received June 4, 2019.
- Accepted in final form November 16, 2019.
- © 2020 American Academy of Neurology
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