Abstracts

RATIONALE: Myoclonic status epilepticus is a characteristic form of status epilepticus commonly observed in comatose survivors of cardiopulmonary resuscitation. It is difficult to treat and has been associated with a poor prognosis for survival. Although some survivors have been reported, the prognosis for myoclonic status epilepticus has been described by some experts to be so poor that treatment is considered futile. This poses major problems for the clinician who must decide whether and how aggressively to treat myoclonic status epilepticus. We report our experience in a large series of patients with myoclonic status epilepticus following cardiopulmonary resuscitation.
At the end of this activity the participants should be able to discuss the association of myoclonic status epilepticus with outcomes after cardiopulmonary resuscitation
METHODS: We reviewed our experience with all patients with myoclonic status epilepticus following cardiopulmonary arrest identified by our neurology services over a twenty-year period. Myoclonic status epilepticus was defined as spontaneous, repetitive, irregular, brief jerks of the axial or peripheral musculature lasting for at least 30 minutes and supported by EEG findings. All patients received antiepileptic drug therapy but no formal, standardized treatment protocol was utilized. Therapy was individualized by managing physicians based on their own concepts of optimal care. We assessed various outcomes including survival at discharge, recovery of consciousness, and functional status. For those individuals who survived to be discharged, we also determined their condition 6 months following discharge.
RESULTS: We evaluated a total of 52 patients with myoclonic status epilepticus following cardiopulmonary resuscitation. Of these 52 patients, 7 (13%) survived to be discharged from the hospital, but of those 7, only 3 survived after 6 months. Of the 3 who survived more than 6 months, only 1 recovered to a good functional level, but she was able to resume her baseline functional activities for several years until she subsequently died due to a new cardiac event. Of the 2 other 6 month survivors, 1 was severely disabled and unable to function independently, and the other remained in a persistent vegetative state. Only 1 of the 52 patients ever recovered consciousness to a good, independent functional level.
CONCLUSIONS: We confirm the generally poor prognosis of myoclonic status epilepticus following cardiopulmonary resuscitation. Of 52 patients, only 1 (2%) made a good, functional neurological recovery. However, 7 survived to be discharged from the hospital, and 3 were alive 6 months later. Although the likelihood of a 6 month survival was only 6%, recovery of some degree of conscious function was 4%, and good recovery of neurological function was 2%, indicating that favorable outcomes are possible. Therefore, we emphasize the importance of individualized assessments considering multiple clinical and neurological variables when determining treatment, prognosis, and potential withdrawal of life support in patients with myoclonic status epilepticus following cardiopulmonary resuscitation.
[Supported by: a grant from the Rosen Foundation.]