Myoclonus in comatose patients with electrographic status epilepticus after cardiac arrest: Corresponding EEG patterns, effects of treatment and outcomes

被引：8

作者：

Nutma, Sjoukje ^{[1
,2
,3
]}

Ruijter, Barry J. ^{[3
]}

Beishuizen, Albertus ^{[1
,2
]}

Tromp, Selma C. ^{[4
]}

Scholten, Erik ^{[5
]}

Horn, Janneke ^{[6
]}

van den Bergh, Walter M. ^{[7
]}

van Kranen-Mastenbroek, Vivianne H. J. M. ^{[8
]}

Thomeer, Elsbeth C. ^{[9
]}

Moudrous, Walid ^{[9
]}

Aries, Marcel ^{[8
]}

van Putten, Michel J. A. M. ^{[1
,2
,3
]}

Hofmeijer, Jeannette ^{[10
]}

Noordzij, P. ^{[11
]}

Moeniralam, H. ^{[11
]}

Seeber, A. ^{[12
]}

Datema, M. ^{[12
]}

van Rootselaar, A. F. ^{[13
]}

Admiraal, M. M. ^{[14
]}

Velseboer, D. C. ^{[14
]}

Koelman, J. H. ^{[13
]}

Elting, J. W. J. ^{[15
]}

Drost, G. ^{[15
]}

Foudraine, N. ^{[16
]}

Kornips, F. ^{[17
]}

Rouhl, R. ^{[18
]}

Hilkman, D. M. W. ^{[18
]}

van Mook, W. ^{[19
]}

Vlooswijk, M. ^{[18
]}

Nijhuis, F. ^{[20
]}

Booij, S. ^{[20
]}

Bernsen, H. ^{[20
]}

Hoedemaekers, A. ^{[21
]}

Doorduin, J. ^{[21
]}

Taccone, F. ^{[22
]}

Gaspard, N. ^{[23
]}

Tromp, S. C. ^{[24
]}

机构：

[1] Medisch Spectrum Twente, Dept Neurol, Enschede, Netherlands

[2] Medisch Spectrum Twente, Dept Clin Neurophysiol, Enschede, Netherlands

[3] Univ Twente, Dept Clin Neurophysiol, Tech Med Ctr, Enschede, Netherlands

[4] Leiden Univ Med Ctr, Dept Neurol, Leiden, Netherlands

[5] Leiden Univ Med Ctr, Dept Clin Neurophysiol, Leiden, Netherlands

[6] St Antonius Hosp, Dept Crit Care, Nieuwegein, Netherlands

[7] Amsterdam Univ Med Ctr, Locat AMC, Dept Crit Care, Amsterdam, Netherlands

[8] Univ Groningen, Univ Med Ctr Groningen, Dept Crit Care, Groningen, Netherlands

[9] Maastricht Univ, Dept Crit Care, Med Ctr, Maastricht, Netherlands

[10] Maasstad Hosp, Dept Neurol & Clin Neurophysiol, Rotterdam, Netherlands

[11] Antonius Hosp, Dept Crit Care, Nieuwegein, Netherlands

[12] Antonius Hosp, Dept Neurol, Nieuwegein, Netherlands

[13] Amsterdam Univ Med Ctr, Dept Neurol, Locat AMC, Amsterdam, Netherlands

[14] Amsterdam Univ Med Ctr, Dept Crit Care, Locat AMC, Amsterdam, Netherlands

[15] Univ Med Ctr Groningen, Dept Neurol, Groningen, Netherlands

[16] VieCuri Med Ctr, Dept Crit Care, Venlo, Netherlands

[17] VieCuri Med Ctr, Dept Neurol, Venlo, Netherlands

[18] Maastricht Univ Med Ctr, Dept Neurol, Maastricht, Netherlands

[19] Maastricht Univ Med Ctr, Dept Crit Care, Maastricht, Netherlands

[20] Canisius Wilhelmina Hosp, Dept Neurol, Nijmegen, Netherlands

[21] Radboud Univ Nijmegen Med Ctr, Dept Neurol, Nijmegen, Netherlands

[22] Univ Libre Bruxelles, Dept Crit Care, Brussels, Belgium

[23] Univ Libre Bruxelles, Dept Neurol, Brussels, Belgium

[24] Leiden Univ Med Ctr, Dept Neurol, Leiden, Netherlands

来源：

RESUSCITATION | 2023年 / 186卷

关键词：

Hypoxic-ischemic encephalopathy; Post cardiac arrest syndrome; Myoclonus; Neuroprotection; Resuscitation; Anti-seizure medication; EEG; CARE; SURVIVORS; SOCIETY;

D O I：

10.1016/j.resuscitation.2023.109745

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Objective: To clarify the significance of any form of myoclonus in comatose patients after cardiac arrest with rhythmic and periodic EEG patterns (RPPs) by analyzing associations between myoclonus and EEG pattern, response to anti-seizure medication and neurological outcome.Design: Post hoc analysis of the prospective randomized Treatment of ELectroencephalographic STatus Epilepticus After Cardiopulmonary Resus-citation (TELSTAR) trial.Setting: Eleven ICUs in the Netherlands and Belgium.Patients: One hundred and fifty-seven adult comatose post-cardiac arrest patients with RPPs on continuous EEG monitoring. Interventions: Anti-seizure medication vs no anti-seizure medication in addition to standard care.Measurements and Main Results: Of 157 patients, 98 (63%) had myoclonus at inclusion. Myoclonus was not associated with one specific RPP type. However, myoclonus was associated with a smaller probability of a continuous EEG background pattern (48% in patients with vs 75% without myoclonus, odds ratio (OR) 0.31; 95% confidence interval (CI) 0.16-0.64) and earlier onset of RPPs (24% vs 9% within 24 hours after cardiac arrest, OR 3.86;95% CI 1.64-9.11). Myoclonus was associated with poor outcome at three months, but not invariably so (poor neurological outcome in 96% vs 82%, p = 0.004). Anti-seizure medication did not improve outcome, regardless of myoclonus presence (6% good outcome in the intervention group vs 2% in the control group, OR 0.33; 95% CI 0.03-3.32).Conclusions: Myoclonus in comatose patients after cardiac arrest with RPPs is associated with poor outcome and discontinuous or suppressed EEG. However, presence of myoclonus does not interact with the effects of anti-seizure medication and cannot predict a poor outcome without false positives.

引用

页数：7

共 15 条

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[10] Free water corrected diffusion tensor imaging discriminates between good and poor outcomes of comatose patients after cardiac arrest
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