From the Guidelines
Myoclonic jerks in post-hypoxic-ischemic encephalopathy (HIE) should be treated with antiseizure medications, such as sodium valproate, levetiracetam, or clonazepam, if they are interfering with mechanical ventilation or are associated with epileptiform activity on EEG.
Treatment Approach
- The treatment approach for myoclonic jerks in post-HIE patients involves the use of antiseizure medications, with the goal of reducing the frequency and severity of myoclonic jerks and preventing further brain injury.
- Sodium valproate, levetiracetam, and clonazepam are commonly used antiseizure medications for the treatment of myoclonic jerks in post-HIE patients, as mentioned in the European Resuscitation Council and European Society of Intensive Care Medicine 2015 guidelines for post-resuscitation care 1.
- Propofol is also effective in suppressing post-anoxic myoclonus, as noted in the same guidelines 1.
- The choice of antiseizure medication depends on the individual patient's response and the presence of any contraindications.
Diagnostic Evaluation
- EEG monitoring is essential in the diagnosis and management of myoclonic jerks in post-HIE patients, as it can help identify epileptiform activity and guide treatment decisions, as recommended by the 2021 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations 1.
- Continuous EEG monitoring may be necessary in some cases to detect episodic or intermittent myoclonic jerks, as mentioned in the 2023 American Heart Association focused update on adult advanced cardiovascular life support 1.
Clinical Considerations
- Myoclonus can be a challenging clinical phenomenon to manage, and treatment should be individualized based on the patient's clinical presentation and response to therapy.
- Status myoclonus, defined as continuous, repetitive myoclonic jerks lasting more than 30 minutes, is associated with a poor prognosis, as noted in the 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care 1.
- The presence of myoclonus or status myoclonus within 7 days after return of spontaneous circulation (ROSC) can be used to predict poor neurological outcome, as suggested by the 2021 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations 1.
From the Research
Treatment Options for Myoclonic Jerks in Post-Hypoxic-Ischemic Encephalopathy (HIE)
- Pharmacological treatments with antiepileptic medications, such as valproic acid, clonazepam, and levetiracetam, may be used to control myoclonus in post-hypoxic-ischemic encephalopathy (HIE) 2, 3, 4, 5
- Deep brain stimulation (DBS), specifically bilateral globus pallidus internus (GPi) DBS, has been shown to be a viable therapeutic option for debilitating post-hypoxic myoclonus 2, 3
- Other treatments that have been tried include benzodiazepines, anaesthetics, agomelatine, levomepromazine, and intrathecal baclofen 3, 6, 5
- The choice of treatment may depend on the severity and type of myoclonus, as well as the individual patient's response to different therapies 2, 3, 4, 6, 5
Specific Treatment Responses
- A case report found that bilateral GPi DBS resulted in a 39% reduction in action myoclonus and improvement in both positive and negative myoclonus 2
- Levetiracetam has been shown to improve post-hypoxic action myoclonus in some cases 4
- Agomelatine has been reported to improve treatment-resistant chronic posthypoxic myoclonus 6
- Co-application of clonazepam, levetiracetam, and primidone has been found to be effective in controlling chronic post-hypoxic myoclonus 5