Neurologic recovery after therapeutic hypothermia in patients with post-cardiac arrest myoclonus


      Early myoclonus in comatose survivors of cardiac arrest, even when it is not myoclonic status epilepticus (MSE), is considered a sign of severe global brain ischemia and has been associated with high rates of mortality and poor neurologic outcomes. We report on three survivors of primary circulatory cardiac arrests who had good neurologic outcomes (two patients with a CPC score = 1 and one patient with a CPC score = 2) after mild therapeutic hypothermia, despite exhibiting massive myoclonus within the first 4 h after return of spontaneous circulation. The concept that early myoclonus heralds a uniformly poor prognosis may need to be reconsidered in the era of post-cardiac arrest mild therapeutic hypothermia.


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        • Krumholz A.
        • Stern B.J.
        • Weiss H.D.
        Outcome from coma after cardiopulmonary resuscitation: relation to seizures and myoclonus.
        Neurology. 1988; 38: 401-405
        • Levy D.E.
        • Caronna J.J.
        • Singer B.H.
        • et al.
        Predicting outcome from hypoxic-ischemic coma.
        JAMA. 1985; 253: 1420-1426
        • Zandbergen E.G.
        • Hijdra A.
        • Koelman J.H.
        • et al.
        Prediction of poor outcome within the first 3 days of postanoxic coma.
        Neurology. 2006; 66: 62-68
        • Jennett B.
        • Bond M.
        Assessment of outcome after severe brain damage: a practical scale.
        Lancet. 1975; 1: 480-484
        • Brain Resuscitation Clinical Trial I Study Group
        A randomized clinical study of cardiopulmonary-cerebral resuscitation: design, methods, and patient characteristics.
        Am J Emerg Med. 1986; 4: 72-86
        • Rossetti A.O.
        • Oddo M.
        • Liaudet L.
        • et al.
        Predictors of awakening from postanoxic status epilepticus after therapeutic hypothermia.
        Neurology. 2009; 72: 744-749
        • Rossetti A.O.
        • Oddo M.
        • Logroscino G.
        • et al.
        Prognostication after cardiac arrest and hypothermia: a prospective study.
        Ann Neurol. 2010; 67: 301-307
        • Obeso J.A.
        • Rothwell J.C.
        • Marsden C.D.
        The spectrum of cortical myoclonus: from focal reflex jerks to spontaneous motor epilepsy.
        Brain. 1985; 108: 193-224
        • Halliday A.M.
        The electrophysiological study of myoclonus in man.
        Brain. 1967; 90: 241-284
        • Jumao-as A.
        • Brenner R.P.
        Myoclonic status epilepticus: a clinical and electroencephalographic study.
        Neurology. 1990; 40: 1199-1202
        • Young G.B.
        • Gilbert J.J.
        • Zochodne D.W.
        The significance of myoclonic status epilepticus in postanoxic coma.
        Neurology. 1990; 40: 1843-1848
        • Wijdicks E.F.
        • Parisi J.E.
        • Sharbrough F.W.
        Prognostic value of myoclonus status in comatose survivors of cardiac arrest.
        Ann Neurol. 1994; 35: 239-243
        • The Hypothermia after Cardiac Arrest (HACA) Study Group
        Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest.
        N Engl J Med. 2002; 346: 549-556
        • Bernard S.A.
        • Gray T.W.
        • Buist M.D.
        • et al.
        Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia.
        N Engl J Med. 2002; 346: 557-563
        • Leithner C.
        • Ploner C.J.
        • Hasper D.
        • et al.
        Does hypothermia influence the predictive value of bilateral absent N20 after cardiac arrest?.
        Neurology. 2010; 74: 965-969
        • English W.A.
        • Giffin N.J.
        • Nolan J.P.
        Myoclonus after cardiac arrest: pitfalls in diagnosis and prognosis.
        Anaesthesia. 2009; 64: 908-911
        • Harper S.J.
        • Wilkes R.G.
        Posthypoxic myoclonus (the Lance-Adams syndrome) in the intensive care unit.
        Anaesthesia. 1991; 46: 199-201
        • Lance J.W.
        • Adams R.D.
        The syndrome of intention or action myoclonus as a sequel to hypoxic encephalopathy.
        Brain. 1963; 86: 111-136
        • Donnino M.W.
        • Rittenberger J.C.
        • Gaieski D.
        • et al.
        The development and implementation of cardiac arrest centers.
        Resuscitation. 2011; 82: 974-978