Reader Response: Prediction of Regaining Consciousness Despite an Early Epileptiform EEG After Cardiac Arrest

I read the study by Barbella et al.1 with great interest. The authors have put forth an easy to calculate EEG prognostic score, which correlates well with clinical outcome after cardiac arrest. Stimulus-induced rhythmic, periodic, or ictal discharges (SIRPIDS) are commonly seen in the EEGs of these critically ill patients. Their clinical significance and how aggressively they should be treated has been debated vigorously. Functional imaging (SPECT) obtained at the time of SIRPIDS has shown no increase in cerebral blood flow, arguing against treatment as seizures.2 SIRPIDS likely reflect a form of brain reactivity and diffuse epileptogenic potential. Although they may regress on treatment with a benzodiazepine, it is likely that aggressive treatment of these discharges in these patients is not warranted and may even be harmful.

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