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For patients with refractory status epilepticus (RSE), international guidelines recommend 24–48 hours of intravenous anesthesia to abort clinical or electrographic seizures. However, the EEG patterns consistent with cessation of RSE are ill-defined. In the analysis by Fisch et al., the investigators retrospectively analyzed clinical and EEG data for 147 patients to determine the incidence rate of induced burst suppression and long-term functional outcome measures and survival. Any burst suppression pattern for patients without anoxic brain injury was achieved in 34% of patients, but this EEG outcome was not associated with persistent seizure termination, in-hospital survival, or return to premorbid level of function. Moreover, any burst suppression pattern was associated with longer length of intensive care unit stay, invasive mechanical ventilation duration, and cumulative hospital stay. The investigators conclude and Dr. Sethi agrees that emphasis should be placed on treating the patient and not the EEG. In a subgroup of patients with anoxic brain injury (n = 45), patients who achieved a higher degree of burst suppression had an incrementally higher odds of seizure termination and in-hospital survival. The investigators suggest these results be interpreted with caution because of the small sample size, inability to adjust for residual confounding, and influence of the “self-fulfilling prophecy” inherent to postarrest neuroprognostication and decision-making.
For patients with refractory status epilepticus (RSE), international guidelines recommend 24–48 hours of intravenous anesthesia to abort clinical or electrographic seizures. However, the EEG patterns consistent with cessation of RSE are ill-defined. In the analysis by Fisch et al., the investigators retrospectively analyzed clinical and EEG data for 147 patients to determine the incidence rate of induced burst suppression and long-term functional outcome measures and survival. Any burst suppression pattern for patients without anoxic brain injury was achieved in 34% of patients, but this EEG outcome was not associated with persistent seizure termination, in-hospital survival, or return to premorbid level of function. Moreover, any burst suppression pattern was associated with longer length of intensive care unit stay, invasive mechanical ventilation duration, and cumulative hospital stay. The investigators conclude and Dr. Sethi agrees that emphasis should be placed on treating the patient and not the EEG. In a subgroup of patients with anoxic brain injury (n = 45), patients who achieved a higher degree of burst suppression had an incrementally higher odds of seizure termination and in-hospital survival. The investigators suggest these results be interpreted with caution because of the small sample size, inability to adjust for residual confounding, and influence of the “self-fulfilling prophecy” inherent to postarrest neuroprognostication and decision-making.
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Author disclosures are available upon request (journal{at}neurology.org).
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