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Seizure Treatment

Question Type:
Intervention
Full Question:
Among adults with ROSC after cardiac arrest in any setting  (P), does does effective seizure treatment  (I), compared with compared with no seizure control  (C), change Survival with Favorable neurological/functional outcome at discharge, 30 days, 60 days, 180 days AND/OR 1 year, Survival only at discharge, 30 days, 60 days, 180 days AND/OR 1 year (O)?
Consensus on Science:
There are no RCTs addressing this question. For the critical outcome of survival with favorable neurologic outcome at discharge, 30 days, 60 days, 180 days, and/or 1 year, very-low-quality evidence (downgraded for lack of concurrent comparative data) from 3 case series(Crepeau 2013, 339; Knight 2013, 396; Hofmeijer 2014, 39) showed only 1/47 post–cardiac arrest patient treated for seizures or SE survived with good neurologic function. The antiepileptic drugs used were widely variable (phenytoin, levetiracetam, sodium valproate, clonazepam, propofol, and midazolam); included general anesthetics; and the drug, dose, and timing of therapy were not consistently reported. In these reports, no post–cardiac arrest patients with seizures were left untreated, providing no insight into the impact of antiepileptic drug therapy on survival or neurologic outcome. In 1 study, effective seizure control was achieved in 4/5 patients treated for seizures, and 0/5 survived with good neurologic function.(Knight 2013, 396) In 1 study, effective seizure control was achieved in 0/24 patients with SE, and 1/24 patients survived with good neurologic function.(Hofmeijer 2014, 39)
Treatment Recommendation:
We recommend the treatment of seizures in post–cardiac arrest patients (strong recommendation, very-low-quality evidence). Values, Preferences, and Task Force Insights In making this recommendation, we acknowledge very low confidence in the estimated treatment effect. However, ongoing seizures have the potential to worsen brain injury, and treatment of recurrent seizures and SE is the standard of care in other patient populations.
CoSTR Attachments:
Copy of Geocadin and Stacey Papers-ILCOR SZ PR and TR review.xlsx    
Copy of Geocadin and Stacey-Bias-ILCOR SZ PR and TR.xlsx    

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