[Effects of piracetam therapy in a case of Lance-Adams syndrome].
We report a 17-year-old female patient with Lance-Adams syndrome caused by anoxic encephalopathy during a severe attack of bronchial asthma. She had difficulty in writing because of action myoclonus in her arms. She also exhibited freezing gait and was unable to walk without cane. Although her gait disturbance resembled those seen in patients with parkinsonism secondary to anoxic encephalopathy, surface electromyography revealed that it was caused by action myoclonus in her legs. The presence of giant somatosensory evoked potentials and enhanced cortical reflexes in response to the electrical stimulation to her posterior tibial nerves supported our diagnosis. A combined therapy with valproate sodium, clonazepam and piracetam (15 g/day) was not effective. However, her freezing gait remarkably improved and she was able to walk without help, after the treatment with sufficient dose of piracetam (21 g/day). Cortical hyperexcitability as revealed by electrophysiological examination also improved. We concluded that the combined therapy with antiepileptic drugs and piracetam was effective in the treatment for action myoclonus. However, because the effects seemed dose-related, the dosage of piracetam needed to be increased until the optimum effects were obtained.
Hoshino
Ai
A
Department of Neuropediatrics, Fuchu, Tokyo. aizm0505@yahoo.co.jp
Kumada
Satoko
S
Yokochi
Fusako
F
Hachiya
Yasuo
Y
Hanafusa
Yukiko
Y
Tomita
Sunao
S
Okiyama
Ryoich
R
Kurihara
Eiji
E
D000293:Adolescent; D000927:Anticonvulsants / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D020233:Gait Disorders, Neurologic / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D002534:Hypoxia, Brain / Q000150:complications; D009207:Myoclonus / Q000188:drug therapy* / Q000209:etiology; D018696:Neuroprotective Agents / Q000008:administration & dosage*; D010889:Piracetam / Q000008:administration & dosage*; D013224:Status Asthmaticus / Q000150:complications; D013577:Syndrome
D000927:Anticonvulsants; D018696:Neuroprotective Agents; D010889:Piracetam