The myoclonus mystery: A case of Lance-Adams Syndrome complicated by withdrawal seizures of alcohol use disorder

Mental Health Clinician 

Authors: Danial Chowdhury, Caitlin McCarthy 



Type: Therapeutic Case Report. Background: Lance-Adams syndrome (LAS) is a rare complication of successful cardiopulmonary resuscitation and is often accompanied by action myoclonus. There are only a few hundred cases of LAS that have been documented across the globe. The often uncontrollable myoclonus activity can start anywhere from days to weeks after a successful resuscitation. While not categorized as a seizure disorder, LAS is commonly treated with anti-epileptic medications. Patient History: The patient is a 41-year-old African-American male with a past medical history significant for hypertension, polysubstance abuse, hyperlipidemia, alcohol use disorder, and a history of a cerebrovascular accident with residual left-sided weakness. The patient has a history of poor medication adherence. After experiencing cardiac arrest with successful resuscitation, the patient experienced a hospitalization complicated by seizure activity, aspiration pneumonia, Torsades de Pointes, and myoclonic jerks secondary to post-anoxic injury to his cerebellum at which point the patient was diagnoses with LAS. Once deemed stable, the patient was discharged on clonazepam 0.5 mg twice daily and sodium valproate delayed-release 500 mg twice daily. Since that time, the patient experienced 16 emergency department visits and eight hospitalizations, the majority of which were due to complications secondary to myoclonus and seizure activity determined to be secondary to alcohol withdrawal. For his LAS treatment, the patient is currently treated with gabapentin 400 mg three times daily, divalproex sodium delayed-release 750 mg twice daily, and clonazepam 0.5 mg twice daily for fifteen days. There are plans for levetiracetam initiation if patient fails divalproex therapy. Review of Literature: A MEDLINE search revealed several case reports of LAS, but no reported cases of concurrent alcohol use disorder with associated withdrawal seizures. The limited data provides the most evidence with divalproex, levetiracetam, clonazepam, and perampanel use for LAS. Conclusion: This case report demonstrates the treatment of myoclonus associated with the rare neurologic disorder, LAS. This is the first case report evaluating the treatment of myoclonus of LAS in a patient with frequent episodes of alcohol-withdrawal seizures. Clinicians should be cognizant of nuances between assessment and treatment of the myoclonus of LAS and the seizures of alcohol withdrawal to ensure appropriate management. 

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