Disclosures: Rebecca Freedman, DO: No financial relationships or conflicts of interest

Case Diagnosis: Lance-Adams syndrome

Case Description: A 32-year-old female with a medical history of severe asthma went into hypoxic respiratory arrest leading to PEA cardiac arrest, with ROSC achieved in 5 minutes. She underwent targeted temperature management and after rewarming, she started having tonic clonic movements in her extremities. On exam, her myoclonic jerks were significantly worse in her lower extremities and milder in her upper extremities. The myoclonic jerks markedly were present at rest and intensified with volitional movement, tactile stimuli, and fatigue. Workup including neuroimaging and EEG were inconclusive. Due to the classical onset, symptomatology, and post-anoxic myoclonus, Lance-Adams syndrome was diagnosed. The patient was admitted to acute inpatient rehabilitation for further management of this movement disorder.

Setting: Acute Inpatient RehabilitationAssessment/

Results: The patient was started on 1g of levetiracetam 4 times daily and clonazepam, which was titrated to 0.75 mg 3 times per day after trials of different dosages. This regimen greatly improved the patient’s symptoms and optimized her ability to participate and progress in therapy. Neuropsychology also played an active role in monitoring her mood and cognition as her symptoms tended to worsen with emotional stressors. Through consistent psychotherapy sessions, the patient adjusted to her current physical limitations and was able to demonstrate significant functional progress.

Discussion: Early diagnosis of Lance-Adams syndrome is important for symptom management, however, evidence-based treatments have not been well established. Our patient’s symptoms substantially improved with a specific regimen of levetiracetam and clonazepam, neuropsychology interventions, and intense PT/OT.

Conclusion: Lance-Adams syndrome is a rare, debilitating condition occurring after a hypoxic event. It is both physically and emotionally challenging. A comprehensive approach, including proper medications and psychotherapy, can facilitate and enhance the rehabilitation process.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/a-comprehensive-approach-to-lance-adams-syndrome-a-case-report/