Observations on comatose survivors of cardiopulmonary resuscitation with generalized myoclonus

• Main Authors: Hägele Stefan, Hundsberger Thomas, Sauer Oliver, Marx Jürgen J, Thömke Frank, Wiechelt Jascha, Weilemann Sacha L
• Format: Article
• Language: English
• Published: BMC 2005-07-01
• Series: BMC Neurology
• Online Access: http://www.biomedcentral.com/1471-2377/5/14

<p>Abstract</p> <p>Background</p> <p>There is only limited data on improvements of critical medical care is resulting in a better outcome of comatose survivors of cardiopulmonary resuscitation (CPR) with generalized myoclonus. There is also a paucity of data on the temporal dynamics of electroenephalographic (EEG) abnormalities in these patients.</p> <p>Methods</p> <p>Serial EEG examinations were done in 50 comatose survivors of CPR with generalized myoclonus seen over an 8 years period.</p> <p>Results</p> <p>Generalized myoclonus occurred within 24 hours after CPR. It was associated with burst-suppression EEG (n = 42), continuous generalized epileptiform discharges (n = 5), alpha-coma-EEG (n = 52), and low amplitude (10 μV <) recording (n = 1). Except in 3 patients, these EEG-patterns were followed by another of these always nonreactive patterns within one day, mainly alpha-coma-EEG (n = 10) and continuous generalized epileptiform discharges (n = 9). Serial recordings disclosed a variety of EEG-sequences composed of these EEG-patterns, finally leading to isoelectric or flat recordings. Forty-five patients died within 2 weeks, 5 patients survived and remained in a permanent vegetative state.</p> <p>Conclusion</p> <p>Generalized myoclonus in comatose survivors of CPR still implies a poor outcome despite advances in critical care medicine. Anticonvulsive drugs are usually ineffective. All postanoxic EEG-patterns are transient and followed by a variety of EEG sequences composed of different EEG patterns, each of which is recognized as an unfavourable sign. Different EEG-patterns in anoxic encephalopathy may reflect different forms of neocortical dysfunction, which occur at different stages of a dynamic process finally leading to severe neuronal loss.</p>