Myoclonic status epilepticus in coma
Myoclonic status epilepticus in coma is a well-recognized complication of the cerebral anoxia resulting from cardiorespiratory arrest (typically after a myocardial infarction or cardiac surgery). It is characterized by spontaneous and stimulus-sensitive myoclonus usually occurring within 24 hours of the coma. To what extent this is really an 'epileptic' state, or is simply a sign of a severely damaged brain, is arguable. The patients generally have burst suppression on
their EEGs, are deeply unconscious, and have signs referable to cerebral oedema. The mortality rates are very high. Survivors are usually left with Lance-Adams type action myoclonus. Whether antiepileptic treatment influences the course of this condition is quite unclear. Some authorities recommend aggressive antiepileptic therapy, and others none at all. It is this author's practice to recommend aggressive antistatus therapy, including anaesthesia, for a 24-hour period, but at this stage, in the absence of any improvement, the antiepileptic therapy should be withdrawn. Barbiturate or non-barbituate infusional anaesthetic drugs are given.
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