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Critical Care Research and Practice
Volume 2017, Article ID 2504058, 7 pages
https://doi.org/10.1155/2017/2504058
Research Article

The Benefit of Neuromuscular Blockade in Patients with Postanoxic Myoclonus Otherwise Obscuring Continuous Electroencephalography (CEEG)

1Department of Neurology, University of Missouri, 5 Hospital Drive, CE 540, Columbia, MO 65211, USA
2Southern Illinois Healthcare, 405 W. Jackson Street, Carbondale, IL 62902, USA
3Novant Health Forsyth Medical Center, 3333 Silas Creek Parkway, Winston-Salem, NC 27103, USA
4Department of Neurology, Texas Tech University Health Sciences Center-El Paso, 4615 Alameda Avenue, El Paso, TX 79905, USA
5Department of Neurology, The University of Chicago Medicine, 5841 S. Maryland Drive, MC2030, Chicago, IL 60637, USA

Correspondence should be addressed to Christopher R. Newey; ude.iruossim.htlaeh@cyewen

Received 30 November 2016; Revised 8 January 2017; Accepted 18 January 2017; Published 6 February 2017

Academic Editor: Romergryko G. Geocadin

Copyright © 2017 Christopher R. Newey et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction. Myoclonus status epilepticus is independently associated with poor outcome in coma patients after cardiac arrest. Determining if myoclonus is of cortical origin on continuous electroencephalography (CEEG) can be difficult secondary to the muscle artifact obscuring the underlying CEEG. The use of a neuromuscular blocker can be useful in these cases. Methods. Retrospective review of CEEG in patients with postanoxic myoclonus who received cisatracurium while being monitored. Results. Twelve patients (mean age: 53.3 years; 58.3% male) met inclusion criteria of clinical postanoxic myoclonus. The initial CEEG patterns immediately prior to neuromuscular blockade showed myoclonic artifact with continuous slowing (50%), burst suppression with myoclonic artifact (41.7%), and continuous myogenic artifact obscuring CEEG (8.3%). After intravenous administration of cisatracurium (0.1 mg–2 mg), reduction in artifact improved quality of CEEG recordings in 9/12 (75%), revealing previously unrecognized patterns: continuous EEG seizures (33.3%), lateralizing slowing (16.7%), burst suppression (16.7%), generalized periodic discharges (8.3%), and, in the patient who had an initially uninterpretable CEEG from myogenic artifact, continuous slowing. Conclusion. Short-acting neuromuscular blockade is useful in determining background cerebral activity on CEEG otherwise partially or completely obscured by muscle artifact in patients with postanoxic myoclonus. Fully understanding background cerebral activity is important in prognostication and treatment, particularly when there are underlying EEG seizures.