Sutter Raoul, Ristic Anette, Rüegg Stephan, Fuhr Peter
Clinic for Intensive Care Medicine, University Hospital Basel, Basel, Switzerland; Division of Clinical Neurophysiology, Department of Neurology, University Hospital Basel, Basel, Switzerland.
Clinic for Intensive Care Medicine, University Hospital Basel, Basel, Switzerland.
Clin Neurophysiol. 2016 Jan;127(1):67-80. doi: 10.1016/j.clinph.2015.08.009. Epub 2015 Aug 29.
Myoclonus is the second most common involuntary non-epileptic movement in intensive care units following tremor-like gestures. Although there are several types of myoclonus, they remain underappreciated, and their diagnostic and prognostic associations are largely ignored. This review discusses clinical, electrophysiological, neuroanatomical, and neuroimaging characteristics of different types of myoclonus in critically ill adults along with their prognostic impact and treatment options. Myoclonus is characterized by a sudden, brief, and sometimes repetitive muscle contraction of body parts, or a brief and sudden cessation of tonic muscle innervation followed by a rapid recovery of tonus. Myoclonus can resemble physiologic and other pathologic involuntary movements. Neurologic injuries, anesthetics, and muscle relaxants interfere with the typical appearance of myoclonus. Identifying "real myoclonus" and determining the neuroanatomical origin are important, as treatment responses depend on the involved neuroanatomical structures. The identification of the type of myoclonus, the involved neuroanatomical structures, and the associated illnesses is essential to direct treatment. In conclusion, the combined clinical, electrophysiological, and neuroradiological examination reliably uncovers the neuroanatomical sources and the pathophysiology of myoclonus. Recognizing cortical myoclonus is critical, as it is treatable and may progress to generalized convulsive seizures or status epilepticus.
肌阵挛是重症监护病房中仅次于震颤样姿势的第二常见的非癫痫性不自主运动。尽管存在多种类型的肌阵挛，但它们仍未得到充分认识，其诊断和预后关联在很大程度上被忽视。本综述讨论了重症成年患者不同类型肌阵挛的临床、电生理、神经解剖和神经影像学特征，以及它们的预后影响和治疗选择。肌阵挛的特征是身体部位突然、短暂且有时重复的肌肉收缩，或紧张性肌肉神经支配的短暂突然停止，随后张力迅速恢复。肌阵挛可能类似于生理性和其他病理性不自主运动。神经损伤、麻醉剂和肌肉松弛剂会干扰肌阵挛的典型表现。识别“真正的肌阵挛”并确定神经解剖学起源很重要，因为治疗反应取决于受累的神经解剖结构。确定肌阵挛的类型、受累的神经解剖结构以及相关疾病对于指导治疗至关重要。总之，临床、电生理和神经放射学检查相结合能够可靠地揭示肌阵挛的神经解剖学来源和病理生理学。识别皮质肌阵挛至关重要，因为它是可治疗的，且可能进展为全身性惊厥发作或癫痫持续状态。
