Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurology, Yale University School of Medicine, New Haven, CT, USA.
Department of Neurology, Yale University School of Medicine, New Haven, CT, USA.
Resuscitation. 2018 Oct;131:114-120. doi: 10.1016/j.resuscitation.2018.06.030. Epub 2018 Jun 28.
To systematically examine the electro-clinical characteristics of post anoxic myoclonus (PAM) and their prognostic implications in comatose cardiac arrest (CA) survivors.
Fifty-nine CA survivors who developed myoclonus within 72 h of arrest and underwent continuous EEG monitoring were included in the study. Retrospective chart review was performed for all relevant clinical variables including time of PAM onset ("early onset" when within 24 h) and semiology (multi-focal, facial/ocular, whole body and limbs only). EEG findings including background, reactivity, epileptiform patterns and EEG correlate to myoclonus were reviewed at 6, 12, 24, 48 and 72 h after the return of spontaneous circulation (ROSC). Outcome was categorized as either with recovery of consciousness (Cerebral Performance Category (CPC) 1-3) or without recovery of consciousness (CPC 4-5) at the time of discharge.
Seven of the 59 patients (11.9%) regained consciousness, including 6/51 (11.8%) with early onset PAM. Patients with recovery of consciousness had shorter time to ROSC, and were more likely to have preserved brainstem reflexes and normal voltage background at all times. No patient with suppression burst or low voltage background (N = 52) at any point regained consciousness. In the subset where precise electro-clinical correlation was possible, all (5/5) those with recovery of consciousness had multi-focal myoclonus and most (4/5) had midline-maximal spikes over a continuous background. No patient with any other semiology (N = 21) regained consciousness.
Early onset PAM is not always associated with lack of recovery of consciousness. EEG can help discriminate between patients who may or may not regain consciousness by the time of hospital discharge.
系统研究缺氧后肌阵挛（PAM）的电临床特征及其对心脏骤停（CA）后昏迷幸存者的预后意义。
本研究纳入了 59 例在心脏骤停后 72 小时内出现肌阵挛且接受连续脑电图监测的 CA 幸存者。对所有相关临床变量（包括 PAM 发作时间[“早期发作”为 24 小时内]和症状学[多灶性、面部/眼部、全身和四肢])进行回顾性图表审查。在自主循环恢复（ROSC）后 6、12、24、48 和 72 小时，回顾脑电图结果，包括背景、反应性、癫痫样模式和与肌阵挛相关的脑电图。出院时根据意识恢复情况（Cerebral Performance Category (CPC) 1-3 或无意识恢复（CPC 4-5）对预后进行分类。
59 例患者中 7 例（11.9%）恢复了意识，其中 6/51 例（11.8%）为早期发作 PAM。恢复意识的患者 ROSC 时间更短，且始终更有可能保留脑干反射和正常电压背景。任何时间点均无抑制爆发或低电压背景（N=52）的患者恢复了意识。在能够进行精确电临床相关性的亚组中，所有（5/5）恢复意识的患者均有多灶性肌阵挛，且大多数（4/5）在连续背景上有中线-最大棘波。任何其他症状学（N=21）的患者均未恢复意识。
早期发作的 PAM 并不总是与意识恢复缺乏相关。脑电图可以帮助区分可能或不可能在出院时恢复意识的患者。
