Prognosis of post-cardiac-arrest anoxic encephalopathy using felbamate: A case report

Abstract

Reliable prognostic methods for cerebral functional outcome of post cardiac-arrest anoxic encephalopathy (AAE) are necessary. Evolution of the Electroencephalogram (EEG) background pattern is a robust predictor of poor or good outcome of patients in this condition. During the first 24 h a rapid recovery toward continuous patterns is associated with a good neurological outcome, but a lack of improvement in this time window represents the opposite, although epileptiform patterns are of unknown significance and effects of treatment with anti-epileptic drugs are indistinct. Generalized periodic epileptiform discharges (GPEDs) and bilateral independent periodic lateralized epileptiform discharges (BIPLEDs) after a severe hypoxemia carried a poor prognosis for survival. Treatment of AAE is symptomatic. Barbiturate coma was historically applied to decrease cerebral metabolic rate of O2 but the clinical benefit was insignificant and minimally affected the grave outcomes. Whether or not treatment of electrographic status epilepticus improves outcome is still under review in the randomized multicenter Treatment of Electroencephalographic STatus epilepticus After cardiopulmonary Resuscitation (TELSTAR) trial (NCT02056236), and no clear data of a standard management has been published. This is a report of cases whose EEG showed severe epileptic abnormality due to AAE and demonstrated remarkable EEG improvement by compassionate use of felbamate.

Keywords

• felbamate
• acute-anoxic encephalopathy
• eeg monitoring
• cardiac arrest
• prognosis