The significance of myoclonic status epilepticus in postanoxic coma

Young, G. Bryan; Gilbert, Jeremy; Zochodne, Douglas W.

doi:10.1212/wnl.40.12.1843

Cited by 163 publications

(104 citation statements)

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“…It is thought that the CM or SM represents the localization of anoxic brain decay in PHM patients 8, 33, 34, 35. The general hypothesis is that damage to the brainstem is worse in terms of prognosis compared to cortical lesions in PAE 1, 7. Generalized myoclonus has been associated with a subcortical origin,7, 8, 9, 10, 11 however in this study we showed that generalized PHM can be of cortical origin as well.…”

Section: Discussioncontrasting

confidence: 42%

“…The general hypothesis is that damage to the brainstem is worse in terms of prognosis compared to cortical lesions in PAE 1, 7. Generalized myoclonus has been associated with a subcortical origin,7, 8, 9, 10, 11 however in this study we showed that generalized PHM can be of cortical origin as well. Interestingly, Gentsch and colleagues (2015) found that the total amount of brain damage predicts outcome in PAE 36.…”

Section: Discussioncontrasting

confidence: 42%

“…This discrepancy might be caused by the presence of variable anoxic/hypoxic damage to the architecture of brain motor pathways in PHM patients. This damage may pave the way for a variety of mechanisms in which cortical generalized PHM can occur 3, 7, 33. For example, in some cases, a generalized jerk could arise from seizures wherein generalized ictal discharges act as the cortical source of PHM 33, 34.…”

Section: Discussionmentioning

confidence: 99%

“…Generalized PHM is associated with a subcortical origin. In this type of PHM the jerks are generalized and synchronous with predominant involvement of the proximal musculature 7, 8, 9, 10, 11. In contrast, focal PHM is associated with a primary cortical origin.…”

Section: Introductionmentioning

confidence: 94%

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The interrelation between clinical presentation and neurophysiology of posthypoxic myoclonus

Zijl

Beudel

Jong

et al. 2018

Ann Clin Transl Neurol

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ObjectivePosthypoxic myoclonus (PHM) in the first few days after resuscitation can be divided clinically into generalized and focal (uni‐ and multifocal) subtypes. The former is associated with a subcortical origin and poor prognosis in patients with postanoxic encephalopathy (PAE), and the latter with a cortical origin and better prognosis. However, use of PHM as prognosticator in PAE is hampered by the modest objectivity in its clinical assessment. Therefore, we aimed to obtain the anatomical origin of PHM with use of neurophysiological investigations, and relate these to its clinical presentation.MethodsThis study included 20 patients (56 ± 18 y/o, 68% M, 2 survived, 1 excluded) with EEG‐EMG‐video recording. Three neurologists classified PHM into generalized or focal PHM. Anatomical origin (cortical/subcortical) was assessed with basic and advanced neurophysiology (Jerk‐Locked Back Averaging, coherence analysis).ResultsClinically assessed origin of PHM did not match the result obtained with neurophysiology: cortical PHM was more likely present in generalized than in focal PHM. In addition, some cases demonstrated co‐occurrence of cortical and subcortical myoclonus. Patients that recovered from PAE had cortical myoclonus (1 generalized, 1 focal).InterpretationHypoxic damage to variable cortical and subcortical areas in the brain may lead to mixed and varying clinical manifestations of myoclonus that differ of those patients with myoclonus generally encountered in the outpatient clinic. The current clinical classification of PHM is not adequately refined to play a pivotal role in guiding treatment decisions to withdraw care. Our neurophysiological characterization of PHM provides specific parameters to be used in designing future comprehensive studies addressing the potential role of PHM as prognosticator in PAE.

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Section: Discussioncontrasting

confidence: 42%

Section: Discussioncontrasting

confidence: 42%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 94%

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The interrelation between clinical presentation and neurophysiology of posthypoxic myoclonus

Zijl

Beudel

Jong

et al. 2018

Ann Clin Transl Neurol

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“…Up to 70% of patients with sepsis are reported to have central nervous system dysfunction (Bolton et al, 1993;Young et al, 1990). One potential cause for the neurological dysfunction in patients with the sepsis syndrome is abnormalities in cerebral blood flow (CBF) secondary to systemic flow disturbances (Hariri et al, 1993).…”

Section: Introductionmentioning

confidence: 99%

The Effect of S. Pneumoniae Bacteremia on Cerebral Blood Flow Autoregulation in Rats

Pedersen

Brandt²,

Knudsen

et al. 2007

J Cereb Blood Flow Metab

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In the present study, we studied the effect of bacteremia on cerebral blood flow (CBF) autoregulation in a rat model of pneumococcal bacteremia and meningitis. Anesthetized rats were divided into five groups (A to E) and inoculated with pneumococci intravenously and normal saline intracisternally (group A, N = 10); saline intravenously and pneumococci intracisternally (group B, N = 10); pneumococci intravenously and pneumococci intracisternally (group C, N = 5); saline intravenously, antipneumococcal antibody intravenously (to prevent bacteremia), and pneumococci intracisternally (group D, N = 10); or saline intravenously and saline intracisternally (group E, N = 10), respectively. Positive cultures occurred in the blood for all rats in groups A, B, and C, and in the cerebrospinal fluid for all rats in groups D and E. Twenty-four hours after inoculation, CBF was measured with laser-Doppler ultrasound during incremental reductions in cerebral perfusion pressure (CPP) by controlled hemorrhage. Autoregulation was preserved in all rats without meningitis (groups A and E) and was lost in 24 of 25 meningitis rats (groups B, C, and D) (P < 0.01). In group A, the lower limit was higher than that of group E (P < 0.05). The slope of the CBF/CPP regression line differed between the meningitis groups (P < 0.001), being steeper for group B than groups C and D, with no difference between these two groups. The results suggest that pneumococcal bacteremia in rats triggers cerebral vasodilation, which right shifts the lower limit of, but does not entirely abolish, CBF autoregulation in the absence of meningitis, and which may further aggravate the vasoparalysis induced by concomitant pneumococcal meningitis.

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Seizures and Epilepsy in the Elderly

Thomas¹

1997

Arch Intern Med

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Seizures and epilepsy in the elderly are an important and increasingly common clinical problem. Major known causes include cerebrovascular disease, brain tumor, degenerative disorders such as Alzheimer disease and cerebral amyloid angiopathy, and toxic-metabolic syndromes such as nonketotic hyperglycemia, postcardiac arrest, and drug-induced seizures. Recognition of seizures may be complicated by relatively unique clinical presentations and differential diagnosis. Nonconvulsive status epilepticus may present as recurrent episodes of confusion. The electroencephalogram is less useful than in the pediatric age group, but has a role in the evaluation of a first seizure and may rarely show characteristic patterns, such as poststroke periodic lateralized epileptiform discharges. Convulsive status, especially that associated with drug toxicity, is associated with increased mortality in the elderly. Pharmacological treatment is complicated by age-related changes in pharmacokinetics and pharmacodynamics and drug-drug and drug-disease interactions. Some of the new antiepileptic drugs may offer advantages for use in the elderly. Oxcarbazepine has fewer drug interactions than carbamazepine, and gabapentin has one, a reduction of felbamate renal elimination. Vigabatrin causes little cognitive dysfunction, while drugs that reduce excitatory amino acid neurotransmission, such as lamotrigine and felbamate, have potentially protective effects in patients with ischemic cerebrovascular disease. The use of barbiturates, primidone, the benzodiazepine clobazam, and the calcium blockers flunarizine and cinnarizine should preferably be avoided in the elderly.

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The significance of myoclonic status epilepticus in postanoxic coma

Cited by 163 publications

References 0 publications

The interrelation between clinical presentation and neurophysiology of posthypoxic myoclonus

The interrelation between clinical presentation and neurophysiology of posthypoxic myoclonus

The Effect of S. Pneumoniae Bacteremia on Cerebral Blood Flow Autoregulation in Rats

Seizures and Epilepsy in the Elderly

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