Related Experiment Video
Updated: Dec 20, 2025
A Multimodal Imaging- and Stimulation-based Method of Evaluating Connectivity-related Brain Excitability in Patients with Epilepsy
Published on: November 13, 2016
MRI-EEG correlation for outcome prediction in postanoxic myoclonus: A multicenter study
Isabelle Beuchat1, Adithya Sivaraju1, Edilberto Amorim1
1From the Department of Clinical Neuroscience, Neurology Service (I.B., A.O.R.), and Department of Diagnostic and Interventional Radiology (V.D.), Lausanne University Hospital and University of Lausanne, Switzerland; Division of Clinical Neurophysiology and Comprehensive Epilepsy Center (A.S., E.J.G.), Department of Neurology, Yale School of Medicine, New Haven, CT; Department of Neurology (E.A., M.B.W.), Massachusetts General Hospital, Harvard Medical School, Boston; and Departments of Radiology (L.H.), Medicine/Cardiology (B.S., D.S.), and Neurology (I.B., K.T., J.W.L.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Objective:
To examine the prognostic ability of the combination of EEG and MRI in identifying patients with good outcome in postanoxic myoclonus (PAM) after cardiac arrest (CA).
Methods:
Adults with PAM who had an MRI within 20 days after CA were identified in 4 prospective CA registries. The primary outcome measure was coma recovery to command following by hospital discharge. Clinical examination included brainstem reflexes and motor activity. EEG was assessed for best background continuity, reactivity, presence of epileptiform activity, and burst suppression with identical bursts (BSIB). MRI was examined for presence of diffusion restriction or fluid-attenuated inversion recovery changes consistent with anoxic brain injury. A prediction model was developed using optimal combination of variables.
Results:
Among 78 patients, 11 (14.1%) recovered at discharge and 6 (7.7%) had good outcome (Cerebral Performance Category < 3) at 3 months. Patients who followed commands were more likely to have pupillary and corneal reflexes, flexion or better motor response, EEG continuity and reactivity, no BSIB, and no anoxic injury on MRI. The combined EEG/MRI variable of continuous background and no anoxic changes on MRI was associated with coma recovery at hospital discharge with sensitivity 91% (95% confidence interval [CI], 0.59-1.00), specificity 99% (95% CI, 0.92-1.00), positive predictive value 91% (95% CI, 0.59-1.00), and negative predictive value 99% (95% CI, 0.92-1.00).
Conclusions:
EEG and MRI are complementary and identify both good and poor outcome in patients with PAM with high accuracy. An MRI should be considered in patients with myoclonus showing continuous or reactive EEGs.
Insights
Combining EEG and MRI accurately predicts outcomes in patients with postanoxic myoclonus (PAM) after cardiac arrest (CA). Continuous EEG background and no anoxic brain injury on MRI indicate a good prognosis.
Area of Science:
- Neurology
- Neuroimaging
- Critical Care Medicine
Background:
- Postanoxic myoclonus (PAM) following cardiac arrest (CA) presents a significant challenge in predicting patient outcomes.
- Early and accurate prognostication is crucial for guiding clinical management and patient care decisions.
Purpose of the Study:
- To evaluate the combined prognostic capability of electroencephalography (EEG) and magnetic resonance imaging (MRI) in identifying patients with good outcomes in PAM.
- To develop a predictive model utilizing EEG and MRI findings for improved outcome prediction in PAM patients.
Main Methods:
- A prospective study involving 78 adult patients with PAM who underwent MRI within 20 days of CA.
- EEG analysis included background continuity, reactivity, epileptiform activity, and burst suppression with identical bursts (BSIB).
- MRI assessment focused on diffusion restriction and fluid-attenuated inversion recovery (FLAIR) changes indicative of anoxic brain injury.
Main Results:
- Only 14.1% of patients recovered to follow commands at discharge, with 7.7% achieving good outcome (Cerebral Performance Category < 3) at 3 months.
- Patients with good outcomes exhibited preserved brainstem reflexes, motor activity, continuous and reactive EEG, absence of BSIB, and no anoxic MRI changes.
- The combination of continuous EEG background and absence of anoxic MRI changes demonstrated high sensitivity (91%) and specificity (99%) for predicting coma recovery.
Conclusions:
- EEG and MRI are complementary tools for accurately predicting both good and poor outcomes in patients with PAM.
- An MRI is recommended for patients with myoclonus exhibiting continuous or reactive EEGs to enhance prognostic accuracy.
More Related Videos
09:57Author Spotlight: Advancing Pediatric Epilepsy Surgery in Children Through Novel Biomarkers and Enhanced Localization
Published on: September 20, 2024
10:22Interictal High Frequency Oscillations Detected with Simultaneous Magnetoencephalography and Electroencephalography as Biomarker of Pediatric Epilepsy
Published on: December 6, 2016