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Propofol in myoclonus status epilepticus in comatose patients following cardiac resuscitation

Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA Competing interests: none declared

Correspondence to:
Correspondence to:
Dr E F M Wijdicks, Department of Neurology, Mayo Clinic–W8B, 200 First Street SW, Rochester, MN 55905, USA;
wijde@mayo.edu

Keywords: cardiac arrest; myoclonus; propofol

Myoclonus status epilepticus has been identified as a poor prognosticating sign in comatose patients following cardiopulmonary resuscitation.¹ These vigorous generalised jerks are considered to be the penultimate phenomenon in a severly damaged brain that is difficult to manage and that may cause difficulty in ventilating the patient. Antiepileptic drugs such as phenytoin or benzodiazepines have not been very successful. When the jerks are particularly severe, neuromuscular junction blockers have been recommended.¹ I report on two comatose patients with myoclonus status epilepticus. Propofol in a subanaesthetic dose muted these movements considerably.

A 77 year old patient with a prior history of rheumatoid arthritis was resuscitated at home after sudden collapse. The emergency medical service found no pulse. He was defibrillated, and after resuscitation of approximately 70 minutes, pulse and blood pressure returned. In the coronary care unit, he had generalised myoclonus in the face, limbs, and abdomen muscles and the movements . . . [Full text of this article]

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				D. D. Bell, P. G. Brindley, D. Forrest, O. A. Muslim, and D. Zygun Management following resuscitation from cardiac arrest: recommendations from the 2003 Rocky Mountain Critical Care Conference: [Conduite a tenir apres la reanimation post-arret cardiaque : recommendations de la conference du Rocky Mountain Critical Care 2003] Can J Anesth, March 1, 2005; 52(3): 309 - 322. [Abstract] [Full Text] [PDF]