Category: Clinical Sciences/Health Conditions
A 75-year-old male with past medical history of COPD and CAD was admitted to inpatient rehabilitation due to critical illness myopathy after a PEA arrest that resulted in an extended hospital stay. His hospital course was complicated by myoclonus that was debilitating to the patient. The myoclonus occurred unpredictably, affecting his arms and legs, and even causing falls. The patient had no history of myoclonus, seizures, or tremors. Prior to arrival to inpatient rehabilitation, an extensive work up was performed which included a head CT and MRI of his brain that showed no acute findings. Twenty-four-hour EEG captured clinical occurrences of myoclonus, but no seizure activity was reported. Neurology was consulted and the patient was trialed on levetiracetam, valproic acid, and clonazepam with minimal relief of his symptoms.
During his stay at inpatient rehabilitation, the patient continued to suffer from frequent myoclonus, and due to the increased risk of falls, his therapists were concerned. A diagnosis of post-hypoxic myoclonus, also known as Lance-Adams Syndrome (LAS), was made by the Neurology consultant. Although there is limited research on LAS, there have been several case reports on the addition of perampanel for treatment. The patient was started on perampanel and within several days the patient had near complete resolution of his myoclonus, and was able to be discharged home safely.
As a result of the introduction of perampanel, the patient’s myoclonus resolved which enabled him to ambulate independently and was discharged home instead of a skilled nursing facility. This case study aims to describe myoclonus as a sequela of hypoxic brain injury, to suggest potential pharmacologic treatment of post-hypoxic myoclonus, and to spread awareness of this uncommon, yet clinically significant syndrome in the inpatient rehabilitation setting.
Evan Berlin– Resident, Vanderbilt University Medical Center
Vartgez Mansourian– Assistant Professor Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center
Emily Tarvin– Assistant Professor of Clinical Medicine, Vanderbilt University School of Medicine