title: Acute posthypoxic myoclonus after cardiopulmonary resuscitation.
abstract: BACKGROUND
  Acute posthypoxic myoclonus (PHM) can occur in patients admitted after cardiopulmonary resuscitation (CPR) and is considered to have a poor prognosis. The origin can be cortical and/or subcortical and this might be an important determinant for treatment options and prognosis. The aim of the study was to investigate whether acute PHM originates from cortical or subcortical structures, using somatosensory evoked potential (SEP) and electroencephalogram (EEG).
  
  
  METHODS
  Patients with acute PHM (focal myoclonus or status myoclonus) within 72 hours after CPR were retrospectively selected from a multicenter cohort study. All patients were treated with hypothermia. Criteria for cortical origin of the myoclonus were: giant SEP potentials; or epileptic activity, status epilepticus, or generalized periodic discharges on the EEG (no back-averaging was used). Good outcome was defined as good recovery or moderate disability after 6 months.
  
  
  RESULTS
  Acute PHM was reported in 79/391 patients (20%). SEPs were available in 51/79 patients and in 27 of them (53%) N20 potentials were present. Giant potentials were seen in 3 patients. EEGs were available in 36/79 patients with 23/36 (64%) patients fulfilling criteria for a cortical origin. Nine patients (12%) had a good outcome. A broad variety of drugs was used for treatment.
  
  
  CONCLUSIONS
  The results of this study show that acute PHM originates from subcortical, as well as cortical structures. Outcome of patients admitted after CPR who develop acute PHM in this cohort was better than previously reported in literature. The broad variety of drugs used for treatment shows the existing uncertainty about optimal treatment.
authors.affiliation: Department of Intensive Care, Academic Medical Center, University of Amsterdam, The Netherlands. a.bouwes@amc.uva.nl
authors.forename: Aline
authors.initials: A
authors.lastname: Bouwes
authors.forename: Daniël
authors.initials: D
authors.lastname: van Poppelen
authors.forename: Johannes H T M
authors.initials: JH
authors.lastname: Koelman
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kuiper
authors.forename: Durk F
authors.initials: DF
authors.lastname: Zandstra
authors.forename: Henry C
authors.initials: HC
authors.lastname: Weinstein
authors.forename: Selma C
authors.initials: SC
authors.lastname: Tromp
authors.forename: Eveline G J
authors.initials: EG
authors.lastname: Zandbergen
authors.forename: Marina A J
authors.initials: MA
authors.lastname: Tijssen
authors.forename: Janneke
authors.initials: J
authors.lastname: Horn
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data*; D015897:Comorbidity; D005260:Female; D006801:Humans; D002534:Hypoxia, Brain / Q000453:epidemiology*; D008297:Male; D009207:Myoclonus / Q000453:epidemiology*; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D013577:Syndrome; D016896:Treatment Outcome