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Anoxic Myoclonic Status Epilepticus

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Status Epilepticus

Part of the book series: Current Clinical Neurology ((CCNEU))

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Abstract

Hypoxic-ischemic encephalopathy occurs after cardiac arrest, and can produce quick, involuntary jerks of myoclonus that originate in the cerebral cortex, subcortical regions, or the spinal cord. Aside from myoclonic status epilepticus, there may be myoclonic shivering, generalized convulsions, focal motor seizures, stimulus-induced jerking, posturing from brainstem herniation with rigidity, tonic eye opening, and late onset myoclonus while awake (Lance–Adams syndrome). The clinical and electroencephalography (EEG) patterns may help distinguish among these states. EEG may reveal generalized periodic discharges on a suppressed background, generalized bursts of spikes, spikes and waves, sharp waves, slow activity, triphasic waves or combinations of these, often termed nonconvulsive status epilepticus. Suppression-burst EEG activity occurs with or without eye or limb movements, while stimulus-induced periodic discharges often accompany eye or limb movements and lie along an ictal-interictal continuum. Seizure patterns are clinically nonconvulsive or subtle, and termed electrographic or subclinical status epilepticus. EEG patterns such as alpha coma, very low-voltage recordings, generalized periodic discharges on a suppressed background, and suppression-bursts with identical bursts predict a dismal prognosis, and treatment is largely futile. Conversely, a reactive EEG background with intact brainstem reflexes, and somatosensory cortical potentials may permit a favorable outcome after respiratory arrest. Therapeutic hypothermia after cardiac arrest with ventricular fibrillation may improve outcome, but EEG patterns with unfavorable prognostic significance remain so even with hypothermia. To avoid a self-fulfilling prophecy, a prolongation of observation time is recommended in uncertain cases.

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Authors and Affiliations

  1. Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Tyrol, Austria

    Gerhard Bauer & Iris Unterberger

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  1. Gerhard Bauer
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  2. Iris Unterberger
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Correspondence to Gerhard Bauer .

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Editors and Affiliations

  1. Department of Neurology, Harvard Medical School, Comprehensive Epilepsy Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA

    Frank W. Drislane

  2. Department of Neurology, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA

    Peter W. Kaplan MBBS

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Bauer, G., Unterberger, I. (2018). Anoxic Myoclonic Status Epilepticus. In: Drislane, F., Kaplan MBBS, P. (eds) Status Epilepticus. Current Clinical Neurology. Springer, Cham. https://doi.org/10.1007/978-3-319-58200-9_13

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