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The following is a summary of “Electrographic and Clinical Determinants of Good Outcome After Postanoxic Status Epilepticus,” published in the February 2025 issue of Neurology by Admiraal et al. 

Postanoxic electrographic status epilepticus (PSE) occurs in one-third of comatose patients after cardiac arrest (CA) and has high mortality. Survivors show late-onset PSE (>24 hours) from a continuous background with no poor outcome indicators. 

Researchers conducted a retrospective study to assess the likelihood of good long-term outcomes in patients with a favorable PSE profile. 

They conducted a prospective observational substudy of the TTM2 trial (2017–2020) on adult comatose patients resuscitated from CA with continuous EEG (cEEG) monitoring. They assessed EEG background and PSE type using standardized American Clinical Neurophysiology Society terminology, blinded to clinical data. On day 4, they performed multimodal prognostication per European postresuscitation guidelines. They defined good outcome as a modified Rankin Scale score of 0–3 at 6 months and conducted follow-ups at 6 and 24 months. 

The results showed that 191 patients underwent cEEG, and 52 (27%) developed possible or definite PSE at a median of 42 hours [IQR 32–46] post-CA. The median age was 70 years [IQR 63–77], and 35% were female. A favorable PSE profile was present in 20 (38%), with 12 (60%) surviving at 6 months and 8 (40%) having a good outcome, increasing the probability of good outcome by 2.7 times. All without a favorable PSE profile had poor outcomes. All with good outcomes obeyed commands within 7 days. At 24 months, all 12 survivors were alive, 7 had good functional outcomes, and most had mild cognitive impairment with life satisfaction similar to the general population. 

Investigators found that PSE was compatible with good outcomes when onset was late, from a continuous background, and without poor outcome indicators. They observed that one-third had a favorable PSE profile, and over a third showed improved consciousness within the first week and had good outcomes. 

Source: neurology.org/doi/10.1212/WNL.0000000000210304