Abstract
Objective
To clarify the significance of any form of myoclonus in comatose patients after cardiac
arrest with rhythmic and periodic EEG patterns (RPPs) by analyzing associations between
myoclonus and EEG pattern, response to anti-seizure medication and neurological outcome.
Design
Post hoc analysis of the prospective randomized Treatment of ELectroencephalographic
STatus Epilepticus After Cardiopulmonary Resuscitation (TELSTAR) trial.
Setting
Eleven ICUs in the Netherlands and Belgium.
Patients
One hundred and fifty-seven adult comatose post-cardiac arrest patients with RPPs
on continuous EEG monitoring.
Interventions
Anti-seizure medication vs no anti-seizure medication in addition to standard care.
Measurements and Main Results
Of 157 patients, 98 (63%) had myoclonus at inclusion. Myoclonus was not associated
with one specific RPP type. However, myoclonus was associated with a smaller probability
of a continuous EEG background pattern (48% in patients with vs 75% without myoclonus,
odds ratio (OR) 0.31; 95% confidence interval (CI) 0.16–0.64) and earlier onset of
RPPs (24% vs 9% within 24 hours after cardiac arrest, OR 3.86;95% CI 1.64–9.11). Myoclonus
was associated with poor outcome at three months, but not invariably so (poor neurological
outcome in 96% vs 82%, p = 0.004). Anti-seizure medication did not improve outcome,
regardless of myoclonus presence (6% good outcome in the intervention group vs 2%
in the control group, OR 0.33; 95% CI 0.03–3.32).
Conclusions
Myoclonus in comatose patients after cardiac arrest with RPPs is associated with poor
outcome and discontinuous or suppressed EEG. However, presence of myoclonus does not
interact with the effects of anti-seizure medication and cannot predict a poor outcome
without false positives.
Keywords
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Article info
Publication history
Published online: February 21, 2023
Accepted:
February 14,
2023
Received in revised form:
February 10,
2023
Received:
December 7,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier B.V. All rights reserved.
