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Semin Neurol 2017; 37(01): 033-039
DOI: 10.1055/s-0036-1593862
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Treatment of Seizures and Postanoxic Status Epilepticus

Alexandra S. Reynolds
1   Department of Neurology, Neurological Institute, Columbia University Medical Center, New York, New York
,
Jan Claassen
2   Division of Neurocritical Care and Neurological Intensive Care Unit, Department of Neurology, Columbia University Medical Center, New York, New York
› Author Affiliations
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Publication History

Publication Date:
01 February 2017 (online)

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Abstract

Seizures are a common occurrence following cardiac arrest and may occur both during targeted temperature management and after rewarming. Postanoxic seizures may be nonconvulsive and very difficult to diagnose without electroencephalography (EEG) or associated with prominent myoclonus. Importantly, to date no randomized controlled trials are available to guide the management of seizures in patients with cardiac arrest. Seizure prophylaxis is not recommended, and when seizures are diagnosed they are typically treated the same as seizures in other patients with acute brain injury. Electroencephalographic abnormalities that are highly epileptiform, but do not fulfill classic seizure criteria, also known as the ictal–interictal continuum, occur frequently and there is no consensus on how to treat these. Several EEG patterns have been associated with poor outcome in retrospective studies. Increasing evidence has emerged that patients may have a favorable outcome, even with status myoclonus and malignant EEG patterns, if aggressive management is pursued.

Keywords

myoclonus - electrographic status epilepticus - nonconvulsive seizures - generalized periodic epileptiform discharges - hypoxic–ischemic encephalopathy
 

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