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

Sjoukje Nutma*, Barry J. Ruijter, Albertus Beishuizen, Selma C. Tromp, Erik Scholten, Janneke Horn, Walter M. van den Bergh, Vivianne H.J.M. van Kranen-Mastenbroek, Elsbeth C. Thomeer, Walid Moudrous, Marcel Aries, Michel J.A.M. van Putten, Jeannette Hofmeijer, TELSTAR Investigators

*Corresponding author for this work

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Abstract

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 Resuscitation (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.

Original languageEnglish
Article number109745
Number of pages7
JournalResuscitation
Volume186
Early online date22 Feb 2023
DOIs
Publication statusPublished - May 2023

Keywords

  • Anti-seizure medication
  • EEG
  • Hypoxic-ischemic encephalopathy
  • Myoclonus
  • Neuroprotection
  • Post cardiac arrest syndrome
  • Resuscitation

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