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Long-term risk of chronic epilepsy in adults after post-anoxic coma and refractory status epilepticus: a retrospective cohort study
  1. Lorenzo Tinti1,2,
  2. Simone Beretta1,2,
  3. Anna Coppo2,3,
  4. Elisa Bianchi4,
  5. Clara Zanchi1,2,
  6. Davide Carone1,2,
  7. Andrea Stabile1,2,
  8. Giada Padovano1,2,
  9. Endrit Sulmina2,3,
  10. Gianluca Greco2,3,
  11. Susanna Diamanti1,2,
  12. Jacopo Cosimo DiFrancesco1,2,
  13. Graziella Bogliun1,2,
  14. Giuseppe Foti2,3,
  15. Carlo Ferrarese1,2,
  16. Ettore Beghi4,
  17. Leonello Avalli2,3
  1. 1 Epilepsy Center, Department of Neurology, San Gerardo Hospital, Monza, Italy
  2. 2 University of Milan–Bicocca, Milano, Italy
  3. 3 Department of Intensive Care, San Gerardo Hospital, Monza, Italy
  4. 4 Neurological Disorders, Mario Negri Institute for Pharmacological Research, Milano, Italy
  1. Correspondence to Dr Lorenzo Tinti, Epilepsy Center, Department of Neurology, San Gerardo Hospital, Monza, Italy; lorenzo.tinti{at}

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Refractory status epilepticus (RSE) has been reported in 20%–30% of patients in coma after cardiac arrest,1 but aggressive and prolonged treatment of RSE in patients with favourable multimodal prognostic indicators might lead to 40%–50% survival and good neurological outcome.2 However, scarce data are available on chronic epilepsy after cardiac arrest, which may severely impair the quality of life in survivors. It is unclear whether these patients are at risk of epilepsy, and whether the occurrence of RSE in the acute phase increases such risk. We investigated the risk of epilepsy in a cohort of cardiac arrest survivors.


Study design

This is a retrospective cohort study approved by the Ethics Committee of San Gerardo Hospital, Monza, Italy, based on a previous prospective study.2 Between January 2011 and May 2016, consecutive adult patients with cardiac arrest treated with hypothermia (34°C), in coma for >24 hours, underwent simplified 4-channel continuous EEG monitoring (cEEG) started within 24 hours of event. If electrographic status epilepticus was detected, regardless of clinical manifestations, patients received an aggressive standardised treatment, according to our published protocol.2

Prognostic EEG patterns

A multimodal prognostic approach was applied in all cases.3 Notably, no included patient received withdrawal of care, intended as active reduction of respiratory support or vasoactive drugs.

Prognostic EEG patterns were identified by on-call epilepsy specialists on cEEG monitoring in the first 5 days after the event.

EEG features were coded according to the ACNS classification for reactivity, continuity and generalised periodic discharges (GPDs),4 and to the …

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  • Contributors LT and SB designed the study. LT prepared the first draft of the manuscript with SB. LT, SB, AC, CZ, DC, AS, GP, ES, GG, SD, JCD and GB were in charge of data acquisition. EBi performed the statistical analysis. GF, CF, EB and LA revised the manuscript for important intellectual contents.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.