ID 253 – Good functional outcome after prolonged postanoxic coma and myoclonic status epilepsy

Abstract

Objective Present the possibility of a reasonable neurological recovery in early onset myoclonic status epilepsy (MSE) and prolonged postanoxic coma (PC). Methods A 43-year-old woman suffered a severe respiratory failure due to an anaphylactic reaction during anaesthetic induction before surgery. She required an urgent tracheostomy and remained in PC with reactive pupils and corneal reflexes, but with no withdrawal reaction to painful stimuli. Over the next hour she showed diffuse myoclonic jerks refractory to different antiepileptic drugs, midazolam and propofol. The EEG pattern revealed diffuse epileptiform discharges suggestive of MSE. Therapeutic hypothermia was induced, as was a barbituric coma using tiopental. Results PC and MSE persisted after suppression of the barbituric coma. The MRI was normal and repeated EEG confirmed MSE with stimulus-induced discharges. Cortical somatosensory evoked potentials (CSEP) were preserved and a second barbituric coma was induced. 48 days later the patient regained consciousness and was able to interact, being discharged on day 90. Conclusions Even in the event of an unfavourable initial prognosis, preserved brainstem reflexes, CSEP and EEG reactivity indicate the requirement for an intensive treatment of postanoxic status epilepsy. Key message Despite early onset of MSE and prolonged PC a global evaluation is necessary before establishing an accurate prognosis.