POOR PROGNOSIS DESPITE SUCCESSFUL TREATMENT OF POSTANOXIC GENERALIZED MYOCLONUS

Abstract

Generalized myoclonus (GM) after cardiopulmonary resuscitation (CPR) implies a poor prognosis.1 Postanoxic GM is usually classified as one type of convulsive status epilepticus,2 which is also reflected by terms like myoclonic status,3 myoclonic status epilepticus,4 or postanoxic status epilepticus.5 Antiepileptic drugs commonly used in the treatment of status epilepticus such as phenytoin or valproate, however, are ineffective in the majority of these patients.3,4,6 Reports of single patients7 and our own observations6 indicated that propofol may control GM. This prompted us to use propofol as standard treatment of postanoxic GM in 60 consecutive comatose survivors of CPR. ### Level of evidence. This is a single observational study without controls (Class IV). ### Methods. We included 28 women, aged 26 to 87 years, mean age 58 years, and 32 men, aged 20 to 82 years, mean age 55 years. All were resuscitated due to cardiac arrest or ventricular fibrillation outside the hospital. None of the patients was treated with mild hypothermia. No patient had a history of epilepsy. All developed GM within 24 hours after CPR. GM always involved the facial muscles, shoulder, and proximal arm muscles. More than half of the patients also had jerks of the diaphragm. As there are numerous sources of acoustic stimuli on intensive care units, it is sometimes impossible to differentiate spontaneously occurring myoclonic jerks from those triggered by acoustic stimuli. Keeping this limitation in mind, about half …