Drugs for epilepsy-like signals during coma do not help recovery

Ten to twenty percent of patients admitted to the intensive care unit (ICU) after cardiac arrest and resuscitation show signs of brain activity that resemble epilepsy. For a long time, it was unclear whether antiepileptic drugs could help with better recovery.

Thus, some of the patients received this drug and some did not. Now, a large-scale study carried out between 2014 and 2021, proves that the drugs make no sense: they do not help recovery, even make a longer stay in intensive care necessary. The research was carried out by a group of eleven hospitals. The researchers, led by Professor Jeannette Hofmeijer of the University of Twente and Rijnstate Hospital in Arnhem, publish their findings in theNew England Journal of Medicine.

About 5,000 patients in the Netherlands require a stay in the intensive care unit, after cardiac arrest and resuscitation. They are then in a coma. The cardiac arrest, at this time, may have damaged the brain to such an extent that half of the patients will not recover from the coma. The other half will also have permanent damage, for example memory functions. Predicting whether a patient will wake up and what their outlook will be is a tall order. One of the instruments used for this purpose is the continuous evaluation of brain signals by EEG (electroencephalography).

While the outcome of the trial may be disappointing in terms of chances of recovery, it also removes uncertainty for the family. The signals point to serious brain damage, which would lead to a much longer stay in intensive care.”

Professor Jeannette Hofmeijer

“Epilepsy continues”

In ten to twenty percent of patients in a coma, something unexpected happens. The EEG shows signs of epilepsy: not as a seizure, but as continuous activity. This type of brain activity is known to indicate severe brain damage with poor outlook. For a long time, it was unclear whether antiepileptic drugs would help improve outcomes. This led to one doctor prescribing the drug, while another did not. From a large study conducted in 11 medical centers in the Netherlands and Belgium, among 172 patients between 2014 and 2021, the conclusion is now that antiepileptic drugs do not provide better recovery. The negative effect is that patients have to stay longer in the ICU: an undesirable situation for the patient, and this puts additional pressure on the healthcare system.

Apart from these continuous epileptic signals, a small group of patients show signs of a typical epileptic seizure: no continuous signals, but a short and heavy seizure. Antiepileptics might help in these situations, but this still needs further research. The results of the study that has just been published are essential for decision-making in the ICU and can remove some of the uncertainties that the patient’s family must face.

The trial was called TELSTAR: JTreatment of EelectroencephalonIgraphic Streetatus epilepticus Aafter cardiopulmonary Rintensive care. The research was made possible by the Netherlands Fund for Epilepsy (“EpilepsieNL”). Jeannette Hofmeijer is a professor of neurophysiology at the University of Twente and a neurologist at Rijnstate Hospital in Arnhem.

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