Observations on comatose survivors of cardiopulmonary resuscitation with generalized myoclonus.
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.


CONCLUSIONS
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.
Thömke
Frank
F
Department of Neurology, Johannes Gutenberg-Universität, Langenbeckstrasse 1, D- 55101 Mainz, Germany. thoemke@neurologie.klinik.uni-mainz.de
Marx
Jürgen J
JJ
Sauer
Oliver
O
Hundsberger
Thomas
T
Hägele
Stefan
S
Wiechelt
Jascha
J
Weilemann
Sacha L
SL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects*; D003128:Coma / Q000150:complications / Q000209:etiology*; D004569:Electroencephalography / Q000379:methods; D004829:Epilepsy, Generalized / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019370:Observation; D012189:Retrospective Studies; D013997:Time Factors