Disclosures: April Hyon, MD: No financial relationships or conflicts of interest

Case Diagnosis: A 76-year-old female with Lance-Adams Syndrome (LAS)

Case Description or Program Description: The patient suffered a cardiac arrest, thought to be secondary to seizure with subsequent respiratory failure. Return of spontaneous circulation was obtained after 2 rounds of CPR. In the ICU, she developed movement-induced myoclonus and was started on levetiracetam and her home primidone (which she takes for a long history of benign essential tremor). Upon admission to inpatient rehabilitation (IPR) 2 weeks later, she had whole body myoclonic jerking triggered by touch. During her IPR stay, she continued to have severe myoclonus that interfered with balance, ambulation, self care, and feeding. It also caused her significant distress. In consultation with Neurology, levetiracetam and primidone doses were increased. Given lack of improvement, she was started on a trial of a low dose of clonazepam at night.

Setting: Inpatient neurorehabilitation unit in a tertiary care hospital

Assessment/Results: Treatment with low-dose clonazepam resulted in improvement in myoclonus and function, without increased sedation. Her therapists noted improved balance, increased confidence during mobility, improved ambulation, decreased tremors with self care tasks, and improved self feeding. She was discharged home with home care services.

Discussion (relevance): LAS (also known as chronic post-hypoxic myoclonus) is rare, with less than 150 cases reported worldwide as of 2009. It is characterized by action myoclonus beginning within days to weeks after cardiopulmonary resuscitation. There are no controlled studies on the best treatment for LAS, which can severely impair patient participation in all aspects of self-care.

Conclusions: Low-dose clonazepam is an effective treatment option for LAS and can improve function, safety, and quality of life for these patients.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/debilitating-lance-adams-syndrome-in-inpatient-rehab-a-case-report/