Predictors of Awakening From Postanoxic Status Epilepticus After Therapeutic Hypothermia

We read with interest the article by Rossetti et al.,1 who studied 6 cardiac arrest (CA) cases with postanoxic status epilepticus (PSE) treated with therapeutic hypothermia. The authors highlight important observations about EEG in the age of therapeutic hypothermia. The study raises the question: If specific EEG patterns emerge after CA, would these patterns now represent a treatable CA with potential for better outcomes? However, the authors apparently did not perform EEG during the hypothermic period in which vecuronium was used. Nonetheless, the authors’ data showed half of their cases with clinically evident seizures at the bedside confirmed by EEG while the other half had PSE detected only on EEG in coma. The authors’ observations demonstrate that not all clinically evident post CA myoclonic jerking represents myoclonus status epilepticus, which is a poor prognostic sign. Recently published American Academy of Neurology guidelines emphasized the utility of EEG after CA.2 It has been our observation in 2 years of using hypothermia …