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Stimulus-sensitive seizures in postanoxic coma
A C Van Cott1, I Blatt, R P Brenner
1Department of Neurology, University of Pittsburgh, School of Medicine, Pennsylvania 15213, USA.
Purpose:
To describe four patients with stimulus-sensitive seizures and myoclonus following severe hypoxic-ischemic injury.
Methods:
In 22 months, four adult patients with myoclonus, generalized tonic-clonic, and clonic seizures following tactile stimulation were identified. EEG and hospital records were reviewed.
Results:
EEGs showed bursts of generalized spike and polyspike activity following tactile stimulation associated with the clinical seizures. No cerebral activity was present between the epileptiform bursts. At times, prolonged periods of suppression were recorded. All patients failed to respond to antiepileptic drugs and died.
Conclusions:
Stimulus-sensitive seizures and myoclonus following anoxia are associated with poor clinical outcome. The presence of seizures and myoclonus in conjunction with epileptiform discharges on EEG confirms that post-anoxic myoclonus is an epileptic state.
Insights
Severe hypoxic-ischemic injury can lead to stimulus-sensitive seizures and myoclonus. This condition, characterized by epileptiform discharges on EEG, is associated with a poor prognosis and resistance to antiepileptic drugs.
Area of Science:
- Neurology
- Neuroscience
- Epileptology
Background:
- Severe hypoxic-ischemic injury is a critical neurological event.
- Myoclonus and seizures are potential sequelae of such injuries.
- Stimulus-sensitive epilepsy presents unique diagnostic and management challenges.
Purpose of the Study:
- To describe four adult patients presenting with stimulus-sensitive seizures and myoclonus following hypoxic-ischemic injury.
- To characterize the clinical and electroencephalographic (EEG) findings in these patients.
- To evaluate the association between these neurological manifestations and clinical outcomes.
Main Methods:
- Retrospective review of EEG and hospital records for four adult patients over 22 months.
- Identification of patients with myoclonus and generalized tonic-clonic/clonic seizures triggered by tactile stimulation.
- Analysis of EEG patterns, including epileptiform discharges and cerebral activity between seizures.
Main Results:
- Patients exhibited myoclonus and seizures triggered by tactile stimulation.
- EEG revealed generalized spike and polyspike bursts correlating with seizures, with periods of suppression between bursts.
- All patients were refractory to antiepileptic drug treatment and ultimately deceased.
Conclusions:
- Stimulus-sensitive seizures and myoclonus following anoxia are indicative of a severe neurological state.
- The findings confirm that post-anoxic myoclonus, when accompanied by epileptiform discharges, represents an epileptic condition.
- The study highlights the poor prognosis associated with this post-anoxic neurological sequela.