Abstracts

Rationale: Post-anoxic status epilepticus (PSE) has been reported at a rate of 12-31%1,2 and has been shown to be an independent predictor of poor outcome in patients after cardiac arrest treated with therapeutic hypothermia3. Reports of extraordinary cases of good outcome4, the possibility of additional brain injury from prolonged seizure activity, and the limited data available have driven support for early and aggressive management of electrographic seizures in comatose survivors of cardiac arrest. No studies have been performed comparing the efficacy of various antiepileptic medications (AEDs) in controlling seizure activity in these patients. This project aimed to describe the current practice and use of AEDs in the treatment of PSE and to provide an initial assessment of the efficacy of individual AEDs. 1. Neurocrit Care. 2009;11: 338-344. 2. Resuscitation. 2013 Mar;84(3): 343-350. 3. Neurology. 2007;69: 255-260. 4. Neurology. 2009;72; 744-749.Methods: This was a single center retrospective cohort study. We identified 53 comatose survivors of cardiac arrest with evidence of status epilepticus per electroencephalography (EEG) report. They were among a cohort of patients who underwent continuous EEG as a part of hypothermia protocol at the Hospital of the University of Pennsylvania between March 2008 and December 2013. Patients were described as having a “likely” response to an AED if that AED was the last antiepileptic medication added, and seizure control was achieved within 24 hours of initiation of that AED.Results: 53 subjects (22% of hypothermia patients) were identified with PSE. 21% of patients with PSE survived to discharge from hospital. Patients with seizure resolution were more likely to survive (40% with seizure resolution vs. 9% with seizure continuation, p=0.007). The most common AEDs administered were phenytoin (75%), levetiracetam (70%), phenobarbital (64%) and valproic acid (28%). Phenytoin was most likely to be administered first, and phenobarbital or valproic acid were more likely to be administered last. There was no significant difference in “likely” response among the individual AEDs (p=0.103), although there was a trend towards a superior response to phenobarbital over levetiracetam (21% vs. 3%). Patient survival was not impacted by exposure to a specific AED (p=0.961).Conclusions: This retrospective study provides preliminary data on the use and efficacy of antiepileptic medications in the treatment of PSE. This data may aid in the design of future prospective trials to further define the efficacy of specific antiepileptic medications in the treatment of PSE.