De Stefano Pia, Leitinger Markus, Misirocchi Francesco, Quintard Hervé, Degano Giulio, Trinka Eugen
EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospital of Geneva, Geneva, Switzerland.
Neuro-Intensive Care Unit, Department of Intensive Care, University Hospital of Geneva, Geneva, Switzerland.
Crit Care Med. 2025 Feb 1;53(2):e410-e423. doi: 10.1097/CCM.0000000000006521. Epub 2024 Nov 22.
Although myoclonus less than or equal to 72 hours after cardiac arrest (CA) is often viewed as a single entity, there is considerable heterogeneity in its clinical and electrophysiology characteristics, and its strength of association with outcome. We reviewed definitions, electroencephalogram, and outcome of myoclonus post-CA to assess the need for consensus and the potential role of electroencephalogram for further research.
PubMed, Embase, and Cochrane databases.
English-language adult (≥ 18 yr) studies from 1966 to May 31, 2024, reporting myoclonus, myoclonic status/status myoclonus (MyS/SM), myoclonic status epilepticus (MSE), and/or early Lance-Adams Syndrome (eLAS) less than or equal to 72 hours post-CA. All study designs were independently screened by two authors.
Data on patients presenting myoclonus, MyS/SM, MSE, and eLAS less than or equal to 72 hours post-CA, along with their definitions, electroencephalogram, and outcomes were extracted. The Newcastle-Ottawa Scale and Cochrane-Risk-of-Bias Assessment tool were used to evaluate study quality (PROSPERO n.CRD42023438107).
Of 585 identified articles, 119 met the inclusion criteria, revealing substantial heterogeneity in definitions, electroencephalogram, and outcomes. Among 3881 patients, myoclonus was reported in 2659, MyS/SM in 883, MSE in 569, and eLAS in 40. Among patients with a defined outcome, a Cerebral Performance Category (CPC) scale of 1-2 was reported in 9.8% of patients with myoclonus, 5.8% with MyS/SM, 5.7% with MSE, and 82.0% with eLAS. Electroencephalogram was recorded in 2714 patients (69.9%). CPC of 1-2 was observed in 1.6% of patients with suppression/suppression burst (SB)/unreactive (U) electroencephalogram, 11.3% with non-SB/U electroencephalogram and status epilepticus (SE), and 22.3% with non-SB/U electroencephalogram without SE.
Heterogeneity in definitions resulted in weak associations with outcomes. We propose to investigate myoclonus by including related electroencephalogram patterns: myoclonus associated with suppression/SB background electroencephalogram, myoclonus with nonsuppression/SB background but SE-electroencephalogram, and myoclonus with nonsuppression/SB background without SE-electroencephalogram. This pragmatic research approach should be validated in future studies.
虽然心脏骤停（CA）后72小时内的肌阵挛通常被视为一个单一实体，但其临床和电生理特征以及与预后的关联强度存在相当大的异质性。我们回顾了CA后肌阵挛的定义、脑电图和预后，以评估达成共识的必要性以及脑电图在进一步研究中的潜在作用。
PubMed、Embase和Cochrane数据库。
1966年至2024年5月31日发表的英文成人（≥18岁）研究，报告CA后72小时内的肌阵挛、肌阵挛状态/状态性肌阵挛（MyS/SM）、肌阵挛持续状态（MSE）和/或早期兰斯-亚当斯综合征（eLAS）。所有研究设计均由两位作者独立筛选。
提取CA后72小时内出现肌阵挛、MyS/SM、MSE和eLAS的患者数据，以及它们的定义、脑电图和预后。使用纽卡斯尔-渥太华量表和Cochrane偏倚风险评估工具评估研究质量（PROSPERO编号：CRD42023438107）。
在585篇已识别的文章中，119篇符合纳入标准，揭示了定义、脑电图和预后方面存在实质性异质性。在3881例患者中，报告有肌阵挛的有2659例，MyS/SM有883例，MSE有569例，eLAS有40例。在有明确预后的患者中，肌阵挛患者中9.8%的脑功能状态分类（CPC）量表评分为1-2，MyS/SM患者为5.8%，MSE患者为5.7%，eLAS患者为82.0%。2714例患者（69.9%）进行了脑电图记录。脑电图表现为抑制/抑制爆发（SB）/无反应（U）的患者中，1.6%的CPC评分为1-2，非SB/U脑电图且伴有癫痫持续状态（SE）的患者中为11.3%，非SB/U脑电图且无SE的患者中为22.3%。
定义的异质性导致与预后的关联较弱。我们建议通过纳入相关脑电图模式来研究肌阵挛：与抑制/SB背景脑电图相关的肌阵挛、具有非抑制/SB背景但伴有SE脑电图的肌阵挛以及具有非抑制/SB背景且无SE脑电图的肌阵挛。这种实用的研究方法应在未来的研究中得到验证。
