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Ben Hadj Salem O, Jamme M, Paul M, Guillemet L, Dumas F, Pène F, Chiche JD, Charpentier J, Mira JP, Outin H, Azabou E, Cariou A. Post-cardiac arrest myoclonus and in ICU mortality: insights from the Parisian Registry of Cardiac Arrest (PROCAT). Neurol Sci 2022; 43:533-540. [PMID: 33895885 PMCID: PMC7670102 DOI: 10.1007/s10072-021-05276-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Post-cardiac arrest myoclonus (PCAM) is a frequent finding in resuscitated patients after cardiac arrest (CA), with rather poor prognostic significance. In this study, we evaluated the association of PCAM within intensive care unit (ICU) mortality from a university hospital CA patients' registry. METHODS Clinical data of consecutive CA survivors admitted in the intensive care unit (ICU) between January and December 2016 at the Paris Cochin University Hospital were assessed from the Parisian registry of cardiac arrest (PROCAT) and analyzed. Neurologic outcome was assessed using the Cerebral Performance Categories (CPC) scale at ICU discharge. Prevalence of PCAM and their association with mortality at ICU discharge were computed. RESULTS One hundred thirty-two (132) patients were included (73.5% males), median age of 66 years. Among them, 37 (28%) developed PCAM during their ICU stay. Only two patients with PCAM survived (5.4%). PCAM was strongly associated with mortality at ICU discharge (odds ratio 17.5 [4.2-123.2]). Sensitivity, specificity, PPV, and NPV of PCAM for prediction of death were 41%, 96%, 95%, and 46%, respectively. CONCLUSION PCAM was observed in nearly one-third of CA patients admitted in ICU. Patients with PCAM had a significantly higher likelihood of ICU mortality and a low likelihood of a good outcome. The prognostic value of PCAM seems rather bleak but remains nuanced and merits study in larger-scale prospective studies taking into account confounding factors.
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Affiliation(s)
- Omar Ben Hadj Salem
- Medical Critical Care Unit, Cochin Hospital, Assistance Publique -Hôpitaux de Paris, Paris, France
- Intensive Care Unit, Centre Hospitalier Intercommunal Meulan- Les Mureaux, Meulan-en-Yvelines, France
| | - Matthieu Jamme
- Medical Critical Care Unit, Cochin Hospital, Assistance Publique -Hôpitaux de Paris, Paris, France
| | - Marine Paul
- Medical Critical Care Unit, Cochin Hospital, Assistance Publique -Hôpitaux de Paris, Paris, France
- UFR de Médecine, Paris-Descartes-Sorbonne-Paris-Cité, Paris, France
| | - Lucie Guillemet
- Medical Critical Care Unit, Cochin Hospital, Assistance Publique -Hôpitaux de Paris, Paris, France
- UFR de Médecine, Paris-Descartes-Sorbonne-Paris-Cité, Paris, France
| | - Florence Dumas
- UFR de Médecine, Paris-Descartes-Sorbonne-Paris-Cité, Paris, France
- Paris Sudden-Death-Expertise-Centre, Paris, France
- Emergency Department, Cochin Hospital, Assistance Publique -Hôpitaux de Paris, Paris, France
| | - Frédéric Pène
- Medical Critical Care Unit, Cochin Hospital, Assistance Publique -Hôpitaux de Paris, Paris, France
- UFR de Médecine, Paris-Descartes-Sorbonne-Paris-Cité, Paris, France
| | - Jean-Daniel Chiche
- Medical Critical Care Unit, Cochin Hospital, Assistance Publique -Hôpitaux de Paris, Paris, France
- UFR de Médecine, Paris-Descartes-Sorbonne-Paris-Cité, Paris, France
| | - Julien Charpentier
- Medical Critical Care Unit, Cochin Hospital, Assistance Publique -Hôpitaux de Paris, Paris, France
- UFR de Médecine, Paris-Descartes-Sorbonne-Paris-Cité, Paris, France
| | - Jean-Paul Mira
- Medical Critical Care Unit, Cochin Hospital, Assistance Publique -Hôpitaux de Paris, Paris, France
- UFR de Médecine, Paris-Descartes-Sorbonne-Paris-Cité, Paris, France
| | - Hervé Outin
- Intensive Care Unit, Poissy-Saint Germain en Laye, Centre Hospitalier Intercommunal, Poissy, France
| | - Eric Azabou
- Clinical Neurophysiology and Neuromodulation Unit, Raymond Poincaré Hospital, Assistance Publique -Hôpitaux de Paris, Garches, France.
- INSERM UMR1173 Infection and Inflammation (2I), University of Versailles-Saint Quentin (UVSQ), Paris Saclay University, 104 Boulevard Raymond Poincaré, 92380, Garches, Paris, France.
| | - Alain Cariou
- Medical Critical Care Unit, Cochin Hospital, Assistance Publique -Hôpitaux de Paris, Paris, France
- UFR de Médecine, Paris-Descartes-Sorbonne-Paris-Cité, Paris, France
- Paris Sudden-Death-Expertise-Centre, Paris, France
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Rodríguez-Blázquez C, Forjaz MJ, Kurtis MM, Balestrino R, Martinez-Martin P. Rating Scales for Movement Disorders With Sleep Disturbances: A Narrative Review. Front Neurol 2018; 9:435. [PMID: 29951032 PMCID: PMC6008651 DOI: 10.3389/fneur.2018.00435] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 05/23/2018] [Indexed: 12/11/2022] Open
Abstract
Introduction: In recent years, a wide variety of rating scales and questionnaires for movement disorders have been developed and published, making reviews on their contents, and attributes convenient for the potential users. Sleep disorders are frequently present in movement disorders, and some movement disorders are accompanied by specific sleep difficulties. Aim: The aim of this study is to perform a narrative review of the most frequently used rating scales for movement disorders with sleep problems, with special attention to those recommended by the International Parkinson and Movement Disorders Society. Methods: Online databases (PubMed, SCOPUS, Web of Science, Google Scholar), related references from papers and websites and personal files were searched for information on comprehensive or global rating scales which assessed sleep disturbances in the following movement disorders: akathisia, chorea, dystonia, essential tremor, myoclonus, multiple system atrophy, Parkinson's disease, progressive supranuclear palsy, and tics and Tourette syndrome. For each rating scale, its objective and characteristics, as well as a summary of its psychometric properties and recommendations of use are described. Results: From 22 rating scales identified for the selected movement disorders, only 5 included specific questions on sleep problems. Movement Disorders Society-Unified Parkinson's Disease Rating scale (MDS-UPDRS), Non-Motor Symptoms Scale and Questionnaire (NMSS and NMSQuest), Scales for Outcomes in Parkinson's Disease (SCOPA)-Autonomic and Progressive Supranuclear Palsy Rating Scale (PSPRS) were the only rating scales that included items for assessing sleep disturbances. Conclusions: Despite sleep problems are frequent in movement disorders, very few of the rating scales addresses these specific symptoms. This may contribute to an infra diagnosis and mistreatment of the sleep problems in patients with movement disorders.
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Affiliation(s)
| | - Maria João Forjaz
- National School of Public Health and REDISSEC, Institute of Health Carlos III, Madrid, Spain
| | - Monica M. Kurtis
- Movement Disorders Unit, Neurology Department, Hospital Ruber International, Madrid, Spain
| | - Roberta Balestrino
- Department of Neuroscience “Rita Levi Montalcini, ” University of Turin, Turin, Italy
| | - Pablo Martinez-Martin
- National Center of Epidemiology and CIBERNED, Institute of Health Carlos III, Madrid, Spain
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van Zijl JC, Beudel M, de Jong BM, van der Naalt J, Zutt R, Lange F, van den Bergh WM, Elting JWJ, Tijssen MAJ. The interrelation between clinical presentation and neurophysiology of posthypoxic myoclonus. Ann Clin Transl Neurol 2018; 5:386-396. [PMID: 29687017 PMCID: PMC5899907 DOI: 10.1002/acn3.514] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 11/20/2017] [Indexed: 11/16/2022] Open
Abstract
Objective Posthypoxic myoclonus (PHM) in the first few days after resuscitation can be divided clinically into generalized and focal (uni‐ and multifocal) subtypes. The former is associated with a subcortical origin and poor prognosis in patients with postanoxic encephalopathy (PAE), and the latter with a cortical origin and better prognosis. However, use of PHM as prognosticator in PAE is hampered by the modest objectivity in its clinical assessment. Therefore, we aimed to obtain the anatomical origin of PHM with use of neurophysiological investigations, and relate these to its clinical presentation. Methods This study included 20 patients (56 ± 18 y/o, 68% M, 2 survived, 1 excluded) with EEG‐EMG‐video recording. Three neurologists classified PHM into generalized or focal PHM. Anatomical origin (cortical/subcortical) was assessed with basic and advanced neurophysiology (Jerk‐Locked Back Averaging, coherence analysis). Results Clinically assessed origin of PHM did not match the result obtained with neurophysiology: cortical PHM was more likely present in generalized than in focal PHM. In addition, some cases demonstrated co‐occurrence of cortical and subcortical myoclonus. Patients that recovered from PAE had cortical myoclonus (1 generalized, 1 focal). Interpretation Hypoxic damage to variable cortical and subcortical areas in the brain may lead to mixed and varying clinical manifestations of myoclonus that differ of those patients with myoclonus generally encountered in the outpatient clinic. The current clinical classification of PHM is not adequately refined to play a pivotal role in guiding treatment decisions to withdraw care. Our neurophysiological characterization of PHM provides specific parameters to be used in designing future comprehensive studies addressing the potential role of PHM as prognosticator in PAE.
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Affiliation(s)
- Jonathan C van Zijl
- Department of Neurology University Medical Center Groningen (UMCG) University of Groningen Hanzeplein 1 9700 RB Groningen Netherlands
| | - Martijn Beudel
- Department of Neurology University Medical Center Groningen (UMCG) University of Groningen Hanzeplein 1 9700 RB Groningen Netherlands
| | - Bauke M de Jong
- Department of Neurology University Medical Center Groningen (UMCG) University of Groningen Hanzeplein 1 9700 RB Groningen Netherlands
| | - Joukje van der Naalt
- Department of Neurology University Medical Center Groningen (UMCG) University of Groningen Hanzeplein 1 9700 RB Groningen Netherlands
| | - Rodi Zutt
- Department of Neurology University Medical Center Groningen (UMCG) University of Groningen Hanzeplein 1 9700 RB Groningen Netherlands
| | - Fiete Lange
- Department of Neurology University Medical Center Groningen (UMCG) University of Groningen Hanzeplein 1 9700 RB Groningen Netherlands.,Department of Clinical Neurophysiology University Medical Center Groningen (UMCG) University of Groningen Hanzeplein 1 9700 RB Groningen Netherlands
| | - Walter M van den Bergh
- Department of Critical Care University Medical Center Groningen (UMCG) University of Groningen Hanzeplein 1 9700 RB Groningen Netherlands
| | - Jan-Willem J Elting
- Department of Neurology University Medical Center Groningen (UMCG) University of Groningen Hanzeplein 1 9700 RB Groningen Netherlands.,Department of Clinical Neurophysiology University Medical Center Groningen (UMCG) University of Groningen Hanzeplein 1 9700 RB Groningen Netherlands
| | - Marina A J Tijssen
- Department of Neurology University Medical Center Groningen (UMCG) University of Groningen Hanzeplein 1 9700 RB Groningen Netherlands
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