Abstracts

Post-Anoxic Periodic-Eye Opening (PAPEO): A Case Series and Literature Review of a Poor Prognostic Indicator

Abstract number : 2.142
Submission category : 4. Clinical Epilepsy / 4D. Prognosis
Year : 2019
Submission ID : 2421589
Source : www.aesnet.org
Presentation date : 12/8/2019 4:04:48 PM
Published date : Nov 25, 2019, 12:14 PM

Authors :
Faisal A. Alsallom, Cleveland Clinic Foundation; Vineet Punia, Cleveland Clinic

Rationale: Post-anoxic myoclonus, typically noted as massive body jerks, is a well-known poor prognostic sign. However, rarely these movements can be subtle and missing them may affect prognostication. Post-anoxic periodic eye-opening (PAPEO) is one such rarely reported phenomenon in the literature. Little is known about the significance or electroencephalogram (EEG) correlations of this finding. The aim of our study was to evaluate and describe patients with PAPEO at our center and report a comprehensive literature review on the same. Methods: Following IRB approval, we retrospectively reviewed patients noted to have PAPEO between January 2017 and May 2019 at the Cleveland Clinic. We accessed their electronic medical records (EMR) to extract clinical data. We also reviewed the digital video electroencephalogram of each patient for characterization of eye-opening. We also conducted a systematic literature review to identify cases of PAPEO and extracted individual patient data. Descriptive statistical tools were used. Results: We identified a total of 5 patients (3 females), average age of 51.2 years (SD +/- 14.74 years), with PAPEO in our database during the study period. The mean cardio-pulmonary resuscitation (CPR) duration was 25.8 minutes (SD +/- 10.3 minutes) followed by therapeutic hypothermia in all study participants. PAPEO appeared transiently for a duration of 27 hours (SD +/- 11 Hours) in all patients and coincided with a burst-suppression pattern on EEG. As PAPEO resolved, there was electro-clinical dissociation of EEG activity, later followed by generalized background suppression in all the patients. Only one patient demonstrated generalized body myoclonus. All patients passed away within 2-7 days following admission. We found 13 cases of PAPEO reported in literature (Table 1). Our data is comparable to previously published cases except for Mori et al. 1981 who reported the survival of their only reported patient. Conclusions: Based on a total of 18 cases, PAPEO is only noted in patients with malignant EEG patterns and is overwhelmingly associated with poor prognosis. It seems that it can be classified into: PAPEO proper and PAPEO plus. PAPEO proper is isolated PAPEO with burst suppression that clinically resolves in less than 2 days but a worsening of EEG (i.e. background suppression). All patients described in the literature with the above characteristics passed away. PAPEO plus is defined as PAPEO associated with other hyperkinetic movements (focal or generalized myoclonus, neck extension, decerebrate posturing, repetitive myoclonus, or swallowing) and/or EEG that does not progress into background suppression. One patient with PAPEO plus features survived as described in the literature. We hope that our description will lead to future studies on this rare phenomenon from other center and an improved understanding of its importance in prognostication after cardiac arrest. Funding: No funding
Clinical Epilepsy