Electro-clinical characteristics and prognostic significance of post anoxic myoclonus

Dhakar, Monica M.B.; Sivaraju, Adithya; Maciel, Carolina; Youn, Teddy S.; Gaspard, Nicolas; Greer, David M.; Hirsch, Lawrence J.; Gilmore, Emily

doi:10.1016/j.resuscitation.2018.06.030

Cited by 32 publications

(42 citation statements)

References 35 publications

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“…However, such specific changes were not seen in the available CT scans during the acute stage. Recent studies analyzing the electro‐clinical significance of aPHM after SCA have reported the presence of midline/vertex spikes over a continuous background as a favorable prognostic marker 10,12 . It is unclear if the vertex and frontocentral location of IEDs in our cohort is an electrographic vestige from the acute stage.…”

Section: Discussionmentioning

confidence: 84%

“…Recent studies analyzing the electroclinical significance of aPHM after SCA have reported the presence of midline/vertex spikes over a continuous background as a favorable prognostic marker. 10,12 It is unclear if the vertex and frontocentral location of IEDs in our cohort is an electrographic vestige from the acute stage. On the other hand, it could represent a signature, long-term epileptogenic marker in the SCA survivors.…”

Section: Discussionmentioning

confidence: 92%

“…Depending on the acute SCA patients analyzed, 20%-75% of them are on ASMs. 12,14 More than two-thirds of our cohort was on ASMs at the time of hospital discharge, and half of them were still on ASMs at the time of the last follow-up. While these figures may be higher than in general SCA survivors, our study highlights that SCA survivors who are treated with ASMs acutely may end up staying on ASMs for a prolonged period.…”

Section: Discussionmentioning

confidence: 95%

“…The acute ASM management of patients with SCA on cEEG remains controversial. Depending on the acute SCA patients analyzed, 20%‐75% of them are on ASMs 12,14 . More than two‐thirds of our cohort was on ASMs at the time of hospital discharge, and half of them were still on ASMs at the time of the last follow‐up.…”

Section: Discussionmentioning

confidence: 99%

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Long‐term electro‐clinical profile of sudden cardiac arrest survivors

et al. 2021

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Objective Recent research has explored the use of continuous EEG (cEEG) monitoring for prognostication of spontaneous cardiac arrest (SCA). However, there is limited literature on the long‐term (post‐hospital discharge) electrographic findings among SCA survivors and their clinical correlates. Our study aims to fill this critical knowledge gap. Methods We retrospectively used our EEG database to identify adults (≥18 years) with SCA history who underwent an outpatient laboratory‐based EEG between 01/01/2011 and 12/31/2018. After electronic medical records (EMR) review, patients with epilepsy history and unclear/poorly documented SCA history were excluded. Outpatient EEGs were reviewed by authors. Acute EEG findings were extracted from the EEG database and EMR. In addition, we extracted data on acute and long‐term neuroimaging findings (CT/MRI), post‐SCA seizures, and anti‐seizure medications (ASM) status. Descriptive analysis and Fisher's exact test were performed. Results We included 32 SCA survivors (50% women; mean age = 52.1 ± 13.6 years) in the study. During a median clinical follow‐up of 28.2 months, 3 patients suffered only clinical seizures, 3 only chronic post‐hypoxic myoclonus, and 5 had both [11 (34.4%) in total]. Interictal epileptiform discharges (IEDs) were noted in one‐third of the patients, which localized to vertex and frontocentral regions in all but one patient. Five (15.6%) of them did not suffer a clinical seizure despite the presence of EAs. Patients who developed epilepsy were significantly more likely to have abnormal neuroimaging findings [10/11 (90.9%)] during the follow‐up compared to the rest of the patients [OR = 25 (95% CI 2.6–>100, P = .002)]. Half of the study cohort was taking ASM at the last follow‐up. Significance Our small study reveals a signature location of IEDs in SCA survivors. Neuroimaging abnormalities seem to be a better indicator of epilepsy development, while EEG may reveal markers of potential epileptogenicity in the absence of clinical seizures. Future, larger studies are needed to confirm our findings.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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Long‐term electro‐clinical profile of sudden cardiac arrest survivors

et al. 2021

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“…However, it is recommended to evaluate them in combination with other prognostic tests. 102,119,127,129,131,[139][140][141][142][143] EEG recordings may also be considered in case of status myoclonus to find related epileptic activity.…”

Section: Clinical Examinationmentioning

confidence: 99%

2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 5. Post-cardiac arrest care

et al. 2021

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The 2020 Korean Post-cardiac Arrest Care Guidelines are medical recommendations derived based on scientific evidence for post-cardiac arrest care. These guidelines are based on the 2020 scientific consensus and treatment recommendations of the International Liaison Committee on Resuscitation and we additionally considered the research papers in the post-cardiac arrest care field which were published after the International Liaison Committee on Resuscitation review. 1,2 In these guidelines, topics which are clinically important and needed further consideration were reviewed in the form of adaptation or hybridization. Meta-analyses or scoping reviews for addi-S42 www.ceemjournal.org 2020 CPR guidelines: post-cardiac arrest care Use of prophylactic antibioticsThe benefit of the routine use of prophylactic antibiotics in pa-S43

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Post cardiac arrest patterns

2022

Hirsch and Brenner's Atlas of EEG in Critical Care

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Electro-clinical characteristics and prognostic significance of post anoxic myoclonus

Abstract: Early onset PAM is not always associated with lack of recovery of consciousness. EEG can help discriminate between patients who may or may not regain consciousness by the time of hospital discharge.

Cited by 32 publications

References 35 publications

Long‐term electro‐clinical profile of sudden cardiac arrest survivors

Long‐term electro‐clinical profile of sudden cardiac arrest survivors

2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 5. Post-cardiac arrest care

Post cardiac arrest patterns

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