Post-anoxic status epilepticus: the prognosis is not always hopeless

In patients who are comatose after resuscitration from cardiac arrest (CA) the prevalence of seizures may attain 33%. A prolonged and consistent epileptiform activity is known as status epilepticus (SE). Regardless of the presence of clinical convulsions, SE after CA is associated with poor neurological outcome and is an independent predictor of mortality. Nevertheless, sporadic cases of good outcome exist, and they need to be identified early within the population of patients with diffuse hypoxic-ischemic brain injury in order to avoid an inappropriate decision of limitation of life-sustaining therapies. Awakening in these patients could be potentially predicted based on specific clinical and electrophysiological signs. These include intact brainstem reflexes, an at least unilaterally present cortical response at SSEPs, a continuous EEG background.