Chronic post-hypoxic myoclonus in intensive care: Lance Adams Syndrome

Abstract

Aim: Posthypoxic myoclonus (PHM) is a rare myoclonus syndrome observed after cardiac arrest, is difficult to control and has no definitive diagnostic method. The pathophysiological mechanism of PHM, also known as Lance Adams Syndrome (LAS), is unknown and definitive treatment options are limited. The aim of this study was to present cases of LAS and the follow-up results of treatment following cardiopulmonary resuscitation (CPR) in our hospital.

Methodology: This study included patients followed up in the intensive care clinic of our hospital between May 2012 and January 2017 after CPR in the intensive care unit (ICU). A retrospective review was made of the record files of patients who were evaluated by the Neurology Department because of epileptic seizures.

Results: Evaluation was made of 19 patients with no history of epilepsy/antiepileptic drug use and treatment initiated by the Neurology Clinic for LAS. The patients comprised of 11 males (58%) and 8 females (42%) with a mean age of 55.89 ± 19.65 y for survivors and 61.50 ± 16.12 years for non-survivors. The mean length of hospital stay was 35 days for survivors and 17.5 days for nonsurvivors. Outcomes were determined as, mortality in 10 cases, long-term care in 7, and discharge withrecovery in 2. Sodium valproate was used in 4 patients and levetiracetam in 15. The 7 patients on
long-term care were found to have been lost in the 3-month period after discharge.

Conclusions: In Lance Adams Syndrome the EEG may not provide any pathological clue or show epileptic changes. An early start to treatment can lead to better prognosis. It can be concluded that after CPR, myoclonic contractions can be reduced, and morbidity and mortality can improve
with early diagnosis and early treatment.