1603 - A Rare Case of Lance-Adams Syndrome (LAS): A Case Report

Case Diagnosis: Lance-Adams Syndrome (LAS) following anoxic brain injury.

Case Description: A 41-year-old male was admitted to an acute care hospital for
management of rhabdomyolysis and alcohol-induced pancreatitis. Three
days later, he was found hanging in an apparent suicide attempt with no pulse.
Cardiopulmonary resuscitation was initiated, with subsequent return of
spontaneous circulation. He was intubated and admitted to the intensive care
unit. Two days after his suicide attempt, he was noted to have persistent seizure-
like activity. However, video electroencephalogram monitoring did not show any
focal epileptiform activity. He was then discharged to an acute rehabilitation
hospital on a regimen of Levetiracetam and Valproic Acid. Despite the use of two
antiepileptic drugs, the patient was noted to have persistent myoclonic activity. In
addition to Levetiracetam and Valproic Acid, he was started on Alprazolam but
was later transitioned to Clonazepam with significant improvement in myoclonus.
Initiation of Piracetam was considered, however this was not approved for use in
the United States.

Discussions:

Fewer than 150 cases of Lance Adams Syndrome (LAS) have been reported in
medical literature. LAS is a form of chronic hypoxic myoclonus that can occur
days to weeks after hypoxic events, such as cardiac arrests. Early and accurate
diagnosis of LAS is essential, as appropriate management of LAS can positively
facilitate improvement in functional outcomes whereas delayed recognition of
LAS could result in inappropriate or delayed treatment using other agents. As
suggested in this patient, early treatment with a combination of Levetiracetam, Clonazepam,
Valproate and possibly Piracetam can be effective in controlling the myoclonus seen in LAS.

Conclusions:

With timely and accurate diagnosis, treatment of LAS with a combination of
Levetiracetam, Valproic Acid, and Clonazepam can serve as an effective medication
regimen to treat patients with post-hypoxic myoclonus.