Myoclonus Status Epilepticus and Post-Anoxic Coma Prognosis

We went around and around the other day at morning report regarding the definition of myoclonus status epilepticus. Here’s what I found in the prognostication literature:

In the 2006 AAN practice parameter, they defined it as “spontaneous, repetitive, unrelenting, generalized multifocal myoclonus involving the face, limbs, and axial musculature in comatose patients”. It seems to me that they’re conflating “generalized” and “multifocal” here, as one implies that the jerks are whole body, whereas the other implies that they involve multiple disparate parts of the body. Relevant to our discussion, there is no mention herein of the EEG correlate (or lack thereof); the myoclonus is only described clinically.

The practice parameter references two papers on this subject. In this one, status myoclonus is undefined. In this one, myoclonus status was defined as “spontaneous or sound-sensitive, repetitive, irregular brief jerks in both face and limb“. Again, EEG findings were not part of the definition of myoclonus status. Most myoclonus status patients had burst suppression, whereas other patterns (polyspike and wave, alpha coma) were not found significantly more often in the myoclonus status patients as compared to their non-myoclonus status coma patients.

About Justin A. Sattin

I'm a vascular neurologist and residency program director. I created this blog in order to share some thoughts with my resident and other colleagues, and to foster my own learning as well.
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