Department of Neurology, Northwestern University Feinberg School of Medicine, 675 N. St. Clair, Suite 7-104, Chicago, IL 60611, United States.
Department of Neurology, Baylor College of Medicine, Houston, TX, United States.
Resuscitation. 2017 Oct;119:76-80. doi: 10.1016/j.resuscitation.2017.07.035. Epub 2017 Aug 8.
Despite decades of research into the prognostic significance of post anoxic myoclonic status (MS), no consistent definition has been used to describe its clinical appearance. We set out to characterize the clinical features of MS and hypothesized that there are distinct clinical subtypes that may have prognostic implications.
Video EEG reports from 2008 to 2016 were searched to identify adult patients with post anoxic MS defined as persistent myoclonus for >30min beginning within 3days of cardiac arrest in a comatose patient. Forty-three patients met inclusion and exclusion criteria. To generate definitions of the clinical features of MS, we reviewed videos of 23 cases and characterized 3 distinct clinical semiologies. An additional 20 cases were independently reviewed and categorized by 3 raters to evaluate inter-rater agreement (IRA). All 43 patients were assigned to a group based on consensus review for the first 23 patients and majority agreement for IRA patients. We also examined the relationship between semiology and outcome.
Three distinct clinical semiologies of MS were identified: Type 1: distal, asynchronous, variable; type 2: axial or axial and distal, asynchronous, variable; and type 3: axial, synchronous, stereotyped. For IRA, Gwet's kappa was 0.64 indicating substantial agreement. Two of 3 type 1 patients (66.6%) and 7.4% of type 2 followed commands whereas none of type 3 followed commands (p=0.03).
We defined and validated a classification system of post anoxic MS based on clinical semiology. This classification may be a useful bedside prognostication tool.
尽管数十年来对缺氧后肌阵挛状态（MS）的预后意义进行了研究，但仍未使用一致的定义来描述其临床表现。我们旨在描述 MS 的临床特征，并假设存在具有预后意义的不同临床亚型。
搜索了 2008 年至 2016 年的视频脑电图报告，以确定在昏迷患者心脏骤停后 3 天内持续>30 分钟的持续性肌阵挛定义为缺氧后 MS 的成年患者。43 名患者符合纳入和排除标准。为了生成 MS 临床特征的定义，我们回顾了 23 例病例的视频，并对 3 种不同的临床半影进行了特征描述。另外 20 例由 3 名评估者进行独立评估和分类，以评估评估者间一致性（IRA）。所有 43 名患者根据前 23 名患者的共识审查和 IRA 患者的多数同意进行分组。我们还检查了半影与结局之间的关系。
确定了 MS 的 3 种不同临床半影：1 型：远端、异步、多变；2 型：轴向或轴向和远端、异步、多变；3 型：轴向、同步、刻板。IRA 时，Gwet's kappa 为 0.64，表明存在实质性一致性。3 型 1 型患者中有 2 例（66.6%）和 2 型患者中有 7.4%可以听从命令，而 3 型患者中无一例可以听从命令（p=0.03）。
我们根据临床半影定义并验证了一种缺氧后 MS 的分类系统。该分类系统可能是一种有用的床边预后预测工具。
