Monica B Dhakar1, Adithya Sivaraju2, Carolina B Maciel3, Teddy S Youn4, Nicolas Gaspard5, David M Greer6, Lawrence J Hirsch2, Emily J Gilmore2. 1. Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurology, Yale University School of Medicine, New Haven, CT, USA. Electronic address: monica.b.dhakar@emory.edu. 2. Department of Neurology, Yale University School of Medicine, New Haven, CT, USA. 3. Department of Neurology, Yale University School of Medicine, New Haven, CT, USA; Department of Neurology, University of Florida, Gainesville, FL, USA. 4. Department of Neurology, University of Florida, Gainesville, FL, USA. 5. Department of Neurology, Yale University School of Medicine, New Haven, CT, USA; Department of Neurology, Université Libre de Bruxelles - Hôpital Erasme, Bruxelles, Belgium. 6. Department of Neurology, Boston University, Boston, MA, USA.
Abstract
OBJECTIVE: To systematically examine the electro-clinical characteristics of post anoxic myoclonus (PAM) and their prognostic implications in comatose cardiac arrest (CA) survivors. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
OBJECTIVE: To systematically examine the electro-clinical characteristics of post anoxic myoclonus (PAM) and their prognostic implications in comatose cardiac arrest (CA) survivors. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Authors: Ayham Alkhachroum; Brian Appavu; Benjamin Rohaut; Jan Claassen; Satoshi Egawa; Brandon Foreman; Nicolas Gaspard; Emily J Gilmore; Lawrence J Hirsch; Pedro Kurtz; Virginie Lambrecq; Julie Kromm; Paul Vespa; Sahar F Zafar Journal: Intensive Care Med Date: 2022-08-23 Impact factor: 41.787
Authors: Isabelle Beuchat; Adithya Sivaraju; Edilberto Amorim; Emily J Gilmore; Vincent Dunet; Andrea O Rossetti; M Brandon Westover; Liangge Hsu; Benjamin M Scirica; Danuzia Silva; Kathleen Tang; Jong Woo Lee Journal: Neurology Date: 2020-06-01 Impact factor: 9.910
Authors: Sonya E Zhou; Mary M Barden; Emily J Gilmore; Octavio M Pontes-Neto; Gisele Sampaio Silva; Pedro Kurtz; Jamary Oliveira-Filho; Pedro Telles Cougo-Pinto; Fernando G Zampieri; Nicholas J Napoli; Jeremy J Theriot; David M Greer; Carolina B Maciel Journal: Crit Care Explor Date: 2021-01-11