Asghar Aleezay, Barnes Benjamin, Aburahma Ahmed, Khan Sabiha, Primera Gabriella, Ravikumar Nakul
University of Massachusetts Chan School of Medicine- Baystate Medical Center, Springfield, MA, United States.
Epilepsy Behav Rep. 2023 Jan 21;21:100589. doi: 10.1016/j.ebr.2023.100589. eCollection 2023.
Post hypoxic myoclonus (PHM) is considered a poor prognostic sign and may influence decisions regarding withdrawal of treatment. PHM is generally categorized in literature as either acute or chronic (also commonly referred to as Lance-Adams Syndrome) based on the onset of myoclonus. However, it may be more accurate to differentiate between the various presentations of PHM based on the clinical characteristics and electroencephalogram (EEG) findings for prognostication. Here, we describe a case of a 33-year-old female who presented after a cardiopulmonary arrest. MRI of the brain and cervical spine on admission were unremarkable. Twelve hours later, she developed generalized, stimulus-sensitive myoclonus suggestive of acute PHM. Various medications were trialed, and her symptoms eventually improved on clonazepam. On day 14, she started having resting and intention myoclonus, and dysarthria, consistent with LAS. Several adjustments were again made to her regimen, and she was eventually switched from clonazepam to baclofen which improved her resting myoclonus. This case highlights that PHM can present differently and have a markedly different outcome. It is important to develop a better understanding of the various types of PHM so as to avoid premature withdrawal of care.
缺氧后肌阵挛（PHM）被认为是预后不良的体征，可能会影响关于停止治疗的决策。在文献中，根据肌阵挛的发作情况，PHM通常分为急性或慢性（也通常称为兰斯-亚当斯综合征）。然而，根据临床特征和脑电图（EEG）结果对PHM的不同表现进行区分以进行预后判断可能更为准确。在此，我们描述一例33岁女性在心肺骤停后出现的病例。入院时脑部和颈椎的MRI检查无异常。12小时后，她出现全身性、刺激敏感型肌阵挛，提示急性PHM。尝试了多种药物，她的症状最终在氯硝西泮治疗下有所改善。在第14天，她开始出现静息性和意向性肌阵挛以及构音障碍，符合兰斯-亚当斯综合征。再次对她的治疗方案进行了几次调整，最终她从氯硝西泮换成了巴氯芬，静息性肌阵挛有所改善。该病例突出表明PHM的表现可能不同，预后也明显不同。更好地了解各种类型的PHM很重要，以免过早停止治疗。
