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Comparative Study
. 2005 Jul 18:5:14.
doi: 10.1186/1471-2377-5-14.

Observations on comatose survivors of cardiopulmonary resuscitation with generalized myoclonus

Frank Thömke  1 , Jürgen J Marx, Oliver Sauer, Thomas Hundsberger, Stefan Hägele, Jascha Wiechelt, Sacha L Weilemann
Affiliations
Comparative Study

Observations on comatose survivors of cardiopulmonary resuscitation with generalized myoclonus

Frank Thömke et al. BMC Neurol. .

Abstract

Background: 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.

Methods: Serial EEG examinations were done in 50 comatose survivors of CPR with generalized myoclonus seen over an 8 years period.

Results: 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 microV <) 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.

Conclusion: 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.

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Figures

Figure 1
Figure 1
Three examples of a burst-suppression-EEG of 3 comatose survivors with generalized myoclonus within 24 hours after cardiopulmonary resuscitation.
Figure 2
Figure 2
Burst-suppression-EEG (upper recording) with periods of continuous epileptiform discharges (lower recording) in a comatose survivors of cardiopulmonary resuscitation with generalized myoclonus.
Figure 3
Figure 3
EEG-sequences and outcome in 50 comatose survivors of cardiopulmonary resuscitation with generalized myoclonus.
Figure 4
Figure 4
Examples of alpha-coma-EEGs on the 2nd day after cardiopulmonary resuscitation in 2 comatose survivors with burst-suppression EEG on the preceding day.
Figure 5
Figure 5
Examples of continuous epileptiform discharges on the 2nd day after cardiopulmonary resuscitation in 2 comatose survivors with burst-suppression EEG on the preceding day.
Figure 6
Figure 6
EEG-sequence of a comatose survivors of cardiopulmonary resuscitation with a burst-suppression-EEG on the 1st day, which was followed by an alpha-coma-EEG on the 2nd and an isolelectric recording on the 4th day.
Figure 7
Figure 7
"Transitional"-EEG-pattern between burst-suppression-EEG and continuous epileptiform discharges (upper recording) or between alpha-and theta-coma EEG (lower recording).
See this image and copyright information in PMC

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