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Status epilepticus

An independent outcome predictor after cerebral anoxia

From the Service de Neurologie (A.O.R., P.A.D.), Service de Médecine Intensive Adulte (L.L., V.R., M.D.S., M.O.), and Institut de Médecine Sociale et Préventive (C.R.), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; and Harvard School of Public Health (G.L.), Boston, MA.

Address correspondence and reprint requests to Dr. Andrea O. Rossetti, Service de Neurologie, CHUV-BH07, CH-1011-Lausanne, Switzerland; andrea.rossetti{at}chuv.ch

Background: Prognosis of status epilepticus (SE) depends on its cause, but there is uncertainty as to whether SE represents an independent outcome predictor for a given etiology. Cerebral anoxia is a relatively homogenous severe encephalopathy. Postanoxic SE is associated to a nearly 100% mortality in this setting; however, it is still unclear whether this is a severity marker of the underlying encephalopathy, or an independent factor influencing outcome. The goal of this study was to assess if postanoxic SE is independently associated with mortality after cerebral anoxia.

Methods: This was a retrospective observation of consecutive comatose survivors of cardiac arrest, including subjects treated with hypothermia. On the subgroup with EEG recordings in the first hospitalization days, univariate and multivariate analyses were applied to potential determinants of in-hospital mortality, and included the following variables: age, gender, type and length of cardiac arrest, occurrence of circulatory shock, presence of therapeutic hypothermia, and electrographic SE.

Results: Out of 166 postanoxic patients, 107 (64%) had an EEG (median latency from admission, 2 days); in this group, therapeutic hypothermia was administered in 59%. Death occurred in 71 (67%) patients. Postanoxic SE was associated with mortality regardless of type of acute cardiac rhythm and administration of hypothermic treatment.

Conclusion: In this hospital-based cohort, postanoxic status epilepticus (SE) seems to be independently related to death in cardiac arrest survivors, suggesting that SE might determine a bad prognosis for a given etiology. Confirmation of these results in a prospective assessment is needed.

Supplemental data at www.neurology.org

Disclosure: The authors report no conflicts of interest.

Received November 27, 2006. Accepted in final form February 21, 2007.

This article has been cited by other articles:

				H. Meierkord, M. Holtkamp, A. O. Rossetti, and G. Logroscino STATUS EPILEPTICUS: AN INDEPENDENT OUTCOME PREDICTOR AFTER CEREBRAL ANOXIA Neurology, May 20, 2008; 70(21): 2015 - 2016. [Full Text] [PDF]

				P. W. Kaplan, Y. Morales, A. O. Rossetti, and G. Logroscino STATUS EPILEPTICUS: AN INDEPENDENT OUTCOME PREDICTOR AFTER CEREBRAL ANOXIA Neurology, April 8, 2008; 70(15): 1295 - 1296. [Full Text] [PDF]

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