Neurologically Favorable Outcome Is Still Possible Despite Myoclonus in Comatose Survivors of Cardiac Arrest

Based on the findings of our review, the latest European Resuscitation Council and European Society of Intensive Care Medicine (ERC-ESICM) guidelines recommend that myoclonus should be used only in combination with other criteria to predict poor neurological outcome after cardiac arrest. A special reason for caution when using myoclonus as a predictor of poor outcome is the heterogeneity of its clinical manifestations, which may range from isolated, focal myoclonic jerks to a generalized, continuous and prolonged myoclonus, commonly described as ‘myoclonus status epilepticus’ or ‘status myoclonus". Results of earlier studies suggested that in patients resuscitated from cardiac arrest the prognosis of status myoclonus is consistently poor, while late-onset action myoclonus, also known as Lance-Adams syndrome, is often compatible with neurological recovery. Unfortunately, the study from Seder et al could not assess the prognosis of these different forms of myoclonus separately, since timing, persistence, and location of myoclonus were not recorded.