Clinical classification of post anoxic myoclonic status

Yara Mikhaeil-Demo, Jay R. Gavvala, Irena I. Bellinski, Micheal P Macken, Aditi Pradeep Narechania, Jessica Warady Templer, Stephen Anthony VanHaerents, Stephan U Schuele, Elizabeth Erway Gerard*

*Corresponding author for this work

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Introduction Despite decades of research into the prognostic significance of post anoxic myoclonic status (MS), no consistent definition has been used to describe its clinical appearance. We set out to characterize the clinical features of MS and hypothesized that there are distinct clinical subtypes that may have prognostic implications. Methods Video EEG reports from 2008 to 2016 were searched to identify adult patients with post anoxic MS defined as persistent myoclonus for >30 min beginning within 3 days of cardiac arrest in a comatose patient. Forty-three patients met inclusion and exclusion criteria. To generate definitions of the clinical features of MS, we reviewed videos of 23 cases and characterized 3 distinct clinical semiologies. An additional 20 cases were independently reviewed and categorized by 3 raters to evaluate inter-rater agreement (IRA). All 43 patients were assigned to a group based on consensus review for the first 23 patients and majority agreement for IRA patients. We also examined the relationship between semiology and outcome. Results Three distinct clinical semiologies of MS were identified: Type 1: distal, asynchronous, variable; type 2: axial or axial and distal, asynchronous, variable; and type 3: axial, synchronous, stereotyped. For IRA, Gwet's kappa was 0.64 indicating substantial agreement. Two of 3 type 1 patients (66.6%) and 7.4% of type 2 followed commands whereas none of type 3 followed commands (p = 0.03). Conclusion We defined and validated a classification system of post anoxic MS based on clinical semiology. This classification may be a useful bedside prognostication tool.

Original languageEnglish (US)
Pages (from-to)76-80
Number of pages5
JournalResuscitation
Volume119
DOIs
StatePublished - Oct 1 2017

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Myoclonus
Coma
Heart Arrest
Electroencephalography
Research

Keywords

  • Cardiac arrest
  • Lance adams
  • Myoclonic status
  • Myoclonic status epilepticus
  • Myoclonus
  • Post anoxic
  • Prognosis

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

Cite this

@article{5033a31e67cd4f8b9ffee2cedc5def8e,
title = "Clinical classification of post anoxic myoclonic status",
abstract = "Introduction Despite decades of research into the prognostic significance of post anoxic myoclonic status (MS), no consistent definition has been used to describe its clinical appearance. We set out to characterize the clinical features of MS and hypothesized that there are distinct clinical subtypes that may have prognostic implications. Methods Video EEG reports from 2008 to 2016 were searched to identify adult patients with post anoxic MS defined as persistent myoclonus for >30 min beginning within 3 days of cardiac arrest in a comatose patient. Forty-three patients met inclusion and exclusion criteria. To generate definitions of the clinical features of MS, we reviewed videos of 23 cases and characterized 3 distinct clinical semiologies. An additional 20 cases were independently reviewed and categorized by 3 raters to evaluate inter-rater agreement (IRA). All 43 patients were assigned to a group based on consensus review for the first 23 patients and majority agreement for IRA patients. We also examined the relationship between semiology and outcome. Results Three distinct clinical semiologies of MS were identified: Type 1: distal, asynchronous, variable; type 2: axial or axial and distal, asynchronous, variable; and type 3: axial, synchronous, stereotyped. For IRA, Gwet's kappa was 0.64 indicating substantial agreement. Two of 3 type 1 patients (66.6{\%}) and 7.4{\%} of type 2 followed commands whereas none of type 3 followed commands (p = 0.03). Conclusion We defined and validated a classification system of post anoxic MS based on clinical semiology. This classification may be a useful bedside prognostication tool.",
keywords = "Cardiac arrest, Lance adams, Myoclonic status, Myoclonic status epilepticus, Myoclonus, Post anoxic, Prognosis",
author = "Yara Mikhaeil-Demo and Gavvala, {Jay R.} and Bellinski, {Irena I.} and Macken, {Micheal P} and Narechania, {Aditi Pradeep} and Templer, {Jessica Warady} and VanHaerents, {Stephen Anthony} and Schuele, {Stephan U} and Gerard, {Elizabeth Erway}",
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month = "10",
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language = "English (US)",
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publisher = "Elsevier Ireland Ltd",

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Clinical classification of post anoxic myoclonic status. / Mikhaeil-Demo, Yara; Gavvala, Jay R.; Bellinski, Irena I.; Macken, Micheal P; Narechania, Aditi Pradeep; Templer, Jessica Warady; VanHaerents, Stephen Anthony; Schuele, Stephan U; Gerard, Elizabeth Erway.

In: Resuscitation, Vol. 119, 01.10.2017, p. 76-80.

Research output: Contribution to journalArticle

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T1 - Clinical classification of post anoxic myoclonic status

AU - Mikhaeil-Demo, Yara

AU - Gavvala, Jay R.

AU - Bellinski, Irena I.

AU - Macken, Micheal P

AU - Narechania, Aditi Pradeep

AU - Templer, Jessica Warady

AU - VanHaerents, Stephen Anthony

AU - Schuele, Stephan U

AU - Gerard, Elizabeth Erway

PY - 2017/10/1

Y1 - 2017/10/1

N2 - Introduction Despite decades of research into the prognostic significance of post anoxic myoclonic status (MS), no consistent definition has been used to describe its clinical appearance. We set out to characterize the clinical features of MS and hypothesized that there are distinct clinical subtypes that may have prognostic implications. Methods Video EEG reports from 2008 to 2016 were searched to identify adult patients with post anoxic MS defined as persistent myoclonus for >30 min beginning within 3 days of cardiac arrest in a comatose patient. Forty-three patients met inclusion and exclusion criteria. To generate definitions of the clinical features of MS, we reviewed videos of 23 cases and characterized 3 distinct clinical semiologies. An additional 20 cases were independently reviewed and categorized by 3 raters to evaluate inter-rater agreement (IRA). All 43 patients were assigned to a group based on consensus review for the first 23 patients and majority agreement for IRA patients. We also examined the relationship between semiology and outcome. Results Three distinct clinical semiologies of MS were identified: Type 1: distal, asynchronous, variable; type 2: axial or axial and distal, asynchronous, variable; and type 3: axial, synchronous, stereotyped. For IRA, Gwet's kappa was 0.64 indicating substantial agreement. Two of 3 type 1 patients (66.6%) and 7.4% of type 2 followed commands whereas none of type 3 followed commands (p = 0.03). Conclusion We defined and validated a classification system of post anoxic MS based on clinical semiology. This classification may be a useful bedside prognostication tool.

AB - Introduction Despite decades of research into the prognostic significance of post anoxic myoclonic status (MS), no consistent definition has been used to describe its clinical appearance. We set out to characterize the clinical features of MS and hypothesized that there are distinct clinical subtypes that may have prognostic implications. Methods Video EEG reports from 2008 to 2016 were searched to identify adult patients with post anoxic MS defined as persistent myoclonus for >30 min beginning within 3 days of cardiac arrest in a comatose patient. Forty-three patients met inclusion and exclusion criteria. To generate definitions of the clinical features of MS, we reviewed videos of 23 cases and characterized 3 distinct clinical semiologies. An additional 20 cases were independently reviewed and categorized by 3 raters to evaluate inter-rater agreement (IRA). All 43 patients were assigned to a group based on consensus review for the first 23 patients and majority agreement for IRA patients. We also examined the relationship between semiology and outcome. Results Three distinct clinical semiologies of MS were identified: Type 1: distal, asynchronous, variable; type 2: axial or axial and distal, asynchronous, variable; and type 3: axial, synchronous, stereotyped. For IRA, Gwet's kappa was 0.64 indicating substantial agreement. Two of 3 type 1 patients (66.6%) and 7.4% of type 2 followed commands whereas none of type 3 followed commands (p = 0.03). Conclusion We defined and validated a classification system of post anoxic MS based on clinical semiology. This classification may be a useful bedside prognostication tool.

KW - Cardiac arrest

KW - Lance adams

KW - Myoclonic status

KW - Myoclonic status epilepticus

KW - Myoclonus

KW - Post anoxic

KW - Prognosis

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