PMC4536289_01
EEG evolution before PER. (a) 12 h post-CPR. Hypothermia (33  C). Sedation with midazolam and morphine chloride. Burst-suppression pattern. Pectoral and laterocervical myoclonia. (b) 72 h post-CPR. Sedation. AEDs: CZP, VPA. Spiky bilateral periodic discharges.. Bipolar montage (sensitivity: 15 muV/mm; speed: 20 s). CPR: cardiopulmonary resuscitation. AED: antiepileptic drug. CZP: clonazepam. VPA: valproic acid.
gr1.jpg
PMC4536289_01_gr1.jpg
f0005
Twelve hours after CPR (still in the hypothermia phase), the patient was observed to have early myoclonic SE with a burst-suppression EEG pattern (Fig. 1a). Despite the introduction of clonazepam and valproic acid (40 mg/kg), electroclinical worsening was observed in the following hours (rewarming phase), with intense spiky bilateral periodic activity on the EEG and increase in myoclonic jerks (Fig. 1b), and levetiracetam (40 mg/kg) was added.
EEG after administration of PER. No sedation. AEDs: PER, 8 mg/24 h; LEV, 1500 mg/12 h; CZP, 0.5 mg/8 h. (a) 8-Hz alpha rhythms and spike-waves in posterior regions. Bipolar montage (sensitivity: 15 muV/mm; speed: 20 s). (b) Spike-waves in parietal and occipital regions. Reactivity present with greater synchronization of background activity to acoustic stimulation. Referential (common average) montage (sensitivity: 10 muV/mm; speed: 20 s).. AED: antiepileptic drug. PER: perampanel, CZP: clonazepam, LEV: levetiracetam.
gr2.jpg
PMC4536289_01_gr2.jpg
f0010
The EEG showed recovery of background activity with hyporeactive 8-Hz alpha rhythms and isolated spike-waves focalized in the posterior regions of both hemispheres; no myoclonia was identified (Fig. 2a and b).