Early myoclonus following anoxic brain injury

Reynolds, Alexandra S.; Rohaut, Benjamin; Holmes, Manisha; Robinson, David; Roth, William; Velázquez, Ángela; Couch, Caroline; Presciutti, Alex; Brodie, Daniel; Moitra, Vivek K.; Rabbani, LeRoy E.; Agarwal, Sachin; Park, Soo‐Jin; Roh, David; Claassen, Jan

doi:10.1212/cpj.0000000000000466

Cited by 23 publications

(19 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Target temperature varied across studies (ESM Table E3). Fifteen studies [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] were included for clinical examination, 12 for biomarkers [37][38][39][40][41][42][43][44][45][46][47][48], 26 for electrophysiology , and 15 for imaging [75][76][77][78][79][80][81][82][83][84][85][86][87][88][89], while 26 studies were included for more than one prognostic modality.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Sensitivity and FPR for index tests based on clinical examination, biomarkers, electrophysiology, and imaging are reported in Tables 3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Clinical myoclonus was described in six studies [26,32,96,104,109,111]. Only one of these studies provided a definition for myoclonus [109].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…A summary of the ACNS EEG terminology is reported in ESM Table E4. 22,23,24,25,26,27,28,29,30,31,32,33,34,35,36) In one study [69], an isoelectric EEG, defined as all activity below 2 µV, predicted poor outcome at 12 and 72 h from ROSC with 0% FPR and high precision (95% CIs 0-4%) ( Table 22). In six studies, a suppressed EEG background defined according to the ACNS terminology (i.e., all activity of the record < 10 µV; see ESM Table E4) almost invariably predicted a poor neurological outcome [52,53,61,68,69,72], especially after 16-24 h from ROSC.…”

Section: And Esm Fig 3)mentioning

confidence: 99%

See 3 more Smart Citations

Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review

et al. 2020

View full text Add to dashboard Cite

Purpose: To assess the ability of clinical examination, blood biomarkers, electrophysiology, or neuroimaging assessed within 7 days from return of spontaneous circulation (ROSC) to predict poor neurological outcome, defined as death, vegetative state, or severe disability (CPC 3-5) at hospital discharge/1 month or later, in comatose adult survivors from cardiac arrest (CA). Methods: PubMed, EMBASE, Web of Science, and the Cochrane Database of Systematic Reviews (January 2013-April 2020) were searched. Sensitivity and false-positive rate (FPR) for each predictor were calculated. Due to heterogeneities in recording times, predictor thresholds, and definition of some predictors, meta-analysis was not performed. Results: Ninety-four studies (30,200 patients) were included. Bilaterally absent pupillary or corneal reflexes after day 4 from ROSC, high blood values of neuron-specific enolase from 24 h after ROSC, absent N20 waves of short-latency somatosensory-evoked potentials (SSEPs) or unequivocal seizures on electroencephalogram (EEG) from the day of ROSC, EEG background suppression or burst-suppression from 24 h after ROSC, diffuse cerebral oedema on brain CT from 2 h after ROSC, or reduced diffusion on brain MRI at 2-5 days after ROSC had 0% FPR for poor outcome in most studies. Risk of bias assessed using the QUIPS tool was high for all predictors. Conclusion: In comatose resuscitated patients, clinical, biochemical, neurophysiological, and radiological tests have a potential to predict poor neurological outcome with no false-positive predictions within the first week after CA. Guidelines should consider the methodological concerns and limited sensitivity for individual modalities. (PROSPERO CRD42019141169

show abstract

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

“…Clinical myoclonus was described in six studies [26,32,96,104,109,111]. Only one of these studies provided a definition for myoclonus [109].…”

Section: Study Characteristicsmentioning

confidence: 99%

Section: And Esm Fig 3)mentioning

confidence: 99%

See 2 more Smart Citations

Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Studies assessing early myoclonus have found it to be associated with a poor neurologic outcome, but with poor specificity. Survival rates with a good neurologic outcome despite the presence of myoclonus within 72 hours of out‐of‐hospital cardiac arrest have been reported at 9%–16% 19‐22 . It may be that different forms of myoclonus, such as myoclonus status epilepticus, have a worse prognosis than that of more benign forms of myoclonus such as Lance‐Adams syndrome 23 .…”

Section: Clinical Examinationmentioning

confidence: 99%

Neurologic prognostication after resuscitation from cardiac arrest

2020

View full text Add to dashboard Cite

Out‐of‐hospital cardiac arrest remains a leading cause of mortality in the United States, and the majority of patients who die after achieving return of spontaneous circulation die from withdrawal of care due to a perceived poor neurologic prognosis. Unfortunately, withdrawal of care often occurs during the first day of admission and research suggests this early withdrawal of care may be premature and result in unnecessary deaths for patients who would have made a full neurologic recovery. In this review, we explore the evidence for neurologic prognostication in the emergency department for patients who achieve return of spontaneous circulation after an out‐of‐hospital cardiac arrest.

show abstract

Posthypoxic Myoclonus and Its Management

Riboldi¹

2021

Movement Disorder Emergencies

View full text Add to dashboard Cite

Early myoclonus following anoxic brain injury

Abstract: Cortical and subcortical myoclonus are seen in every sixth patient with cardiac arrest and cannot be distinguished using clinical criteria. Either condition may have good functional outcomes.

Cited by 23 publications

References 27 publications

Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review

Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review

Neurologic prognostication after resuscitation from cardiac arrest

Posthypoxic Myoclonus and Its Management

Contact Info

Product

Resources

About