• Frank Thömke, Jürgen J Marx, Oliver Sauer, Thomas Hundsberger, Stefan Hägele, Jascha Wiechelt, and Sacha L Weilemann.
• Department of Neurology, Johannes Gutenberg-Universität, Langenbeckstrasse 1, D- 55101 Mainz, Germany. thoemke@neurologie.klinik.uni-mainz.de
• Bmc Neurol. 2005 Jan 1; 5: 14.

BackgroundThere 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.MethodsSerial EEG examinations were done in 50 comatose survivors of CPR with generalized myoclonus seen over an 8 years period.ResultsGeneralized 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.ConclusionGeneralized 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.

22 keywords...

hide…