Acute Posthypoxic Myoclonus After Pediatric Cardiac Arrest: EEG Correlates and Outcome
Julia S Keenan1,2, Dana B Harrar1,2,3, Katelyn Staso3
1Department of Neurology, Children's National Hospital, Washington, DC.
Insights
Posthypoxic myoclonus (PHM) is common in children after cardiac arrest (CA), affecting 9% of patients. This condition is linked to increased brain injury and mortality, highlighting its significance in pediatric critical care.
Area of Science:
- Pediatric Critical Care Medicine
- Neuroscience
- Neurology
Background:
- Posthypoxic myoclonus (PHM) is a known poor prognostic indicator in adults following cardiac arrest (CA).
- Limited research exists on PHM in pediatric populations.
- Understanding PHM in children is crucial for improving outcomes.
Purpose of the Study:
- To determine the incidence of PHM in pediatric patients after CA.
- To describe electroencephalogram (EEG) features associated with PHM.
- To evaluate the outcomes, including mortality and cerebral injury, of pediatric PHM.
Main Methods:
- Retrospective single-center review of 106 pediatric patients over 3 years.
- Exclusion of patients with pre-existing cerebral injury, epilepsy, or ICU admission.
- Chi-square analysis to assess PHM association with mortality and brain injury.
Main Results:
- PHM was identified in 9% (10/106) of pediatric CA patients.
- Patients with PHM showed significantly higher rates of brain injury (100% vs. 53%) and mortality (90% vs. 38%).
- No significant difference in mortality was observed when comparing PHM patients to those with brain injury or severe EEG abnormalities.
Conclusions:
- PHM is a frequent occurrence in pediatric patients following cardiac arrest.
- PHM is strongly associated with increased cerebral injury and mortality in this population.
- The presence of PHM indicates a severe neurological insult post-cardiac arrest.
Background And Objectives:
Posthypoxic myoclonus (PHM) is associated with a poor prognosis in adults. Studies on this topic are limited in pediatrics. We aim to describe the incidence, EEG features, and outcomes of PHM after pediatric cardiac arrest (CA).
Methods:
This is a 3-year retrospective single-center review of pediatric patients with CA. Patients with known cerebral injury and/or epilepsy and those admitted to the cardiac intensive care unit were excluded. Chi-square analysis was used to assess associations of PHM with mortality and cerebral injury. Further analysis compared these outcome metrics between patients with PHM and those without PHM but with cerebral injury, severe EEG background abnormalities, and/or electrographic seizures.
Results:
A total of 106 patients met inclusion criteria (median age 2.5 years [interquartile range 0.67-10.6 years], 30% [32/106] female). Ten patients had PHM (9%, 10/106), and 80% (8/10) had an EEG correlate. Patients with PHM had increased rates of brain injury (100% vs 53%, p = 0.005) and mortality (90% vs 38%, p = 0.002) compared with the entire group. When comparing patients with PHM with patients with brain injury or severe EEG background abnormalities, there was no difference in mortality.
Discussion:
PHM is common after pediatric CA and is associated with brain injury and mortality.
Related Concept Videos
01:13Seizures: Classification
Seizures are typically classified into two main categories: focal and generalized seizures.
Focal Seizures
Focal seizures originate from specific regions of the brain. These seizures are further sub-classified into two types:
01:24Epilepsy and Seizures: Overview
Various factors can trigger epilepsy, including genetic factors, brain damage, metabolic causes, and unknown etiology. Diagnosis of epilepsy involves electroencephalography (EEG), which...
01:29Electrocardiogram
Three major waveforms are present in a typical ECG recording: the P wave, the QRS complex, and...