[Treatment and long-term follow-up of post-anoxic myoclonus].
Postanoxic myoclonic (Lance-Adams) syndrome is characterized by myoclonic jerking provoked by intention or external stimuli. The authors present a patient in whom high-dose piracetam treatment resulted in a long-term improvement. Their female patient jumped into the river in order to commit a suicide. She was rescued in the state of clinical death. After a successful reanimation, she was comatose for 16 days. Despite the adequate rehabilitation therapy, her movement status did not change, due to jerking induced by external stimuli. Two months after the asphyxia, the patient was still confined to bed. The authors diagnosed her illness as Lance-Adams syndrome, based on the clinical history and symptoms. Valproic acid and clonazepam was introduced and, after a few days 24 g piracetam was added intravenously. After the first piracetam infusion, the jerking dramatically diminished, she was able to walk with some help. During the 4-years follow up, she received orally 19.2 g piracetam, 1500 mg valproic acid and 6 mg clonazepam. Now she is able to walk without help for a short distance and her cognitive functions have almost completely restituted.


CONCLUSIONS
Lance-Adams syndrome is usually recognized only in a late phase, preventing the early rehabilitation. The trias consisting of anoxia, coma, and stimulus-sensitive myoclonus, however, can be easily recognized, and the adequate treatment may lead to a significant improvement.
Janszky
J
J
Epilepszia Centrum, Országos Pszichiátriai és Neurológiai Intézet, Budapest. janszky@opni.hu
Holló
A
A
Halász
P
P
D000328:Adult; D003072:Cognition Disorders / Q000188:drug therapy* / Q000209:etiology; D003865:Major Depressive Disorder / Q000150:complications / Q000188:drug therapy; D005260:Female; D006801:Humans; D002534:Hypoxia, Brain / Q000150:complications* / Q000209:etiology; D009207:Myoclonus / Q000188:drug therapy* / Q000209:etiology; D015701:Near Drowning; D018696:Neuroprotective Agents / Q000627:therapeutic use*; D018697:Nootropic Agents / Q000627:therapeutic use*; D010889:Piracetam / Q000627:therapeutic use*; D013406:Suicide, Attempted; D013577:Syndrome; D013997:Time Factors; D016896:Treatment Outcome
D018696:Neuroprotective Agents; D018697:Nootropic Agents; D010889:Piracetam