Early Lance–Adams syndrome after cardiac arrest: Prevalence, time to return to awareness, and outcome in a large cohort. (June 2017)

• Record Type: Journal Article
• Authors: Aicua Rapun, Irene; Novy, Jan; Solari, Daria; Oddo, Mauro; Rossetti, Andrea O.
• Is Part Of: Resuscitation. Volume 115(2017)
• Page Start: 169
• Page End: 172
• Publication Date: 2017-06
• Subjects: Hypoxic-ischemic encephalopathy -- Antiepileptic drug -- Myoclonus -- Prognosis -- EEG; Resuscitation -- Periodicals; Resuscitation -- Periodicals; Réanimation -- Périodiques; Electronic journals; 616.025
• DOI: 10.1016/j.resuscitation.2017.03.020
• Languages: English
• ISSNs: 0300-9572

Abstract

Abstract: Introduction: Early myoclonus after cardiac arrest (CA) is traditionally viewed as a poor prognostic sign (status myoclonus). However, some patients may present early Lance–Adams syndrome (LAS): under appropriate treatment, they can reach a satisfactory functional outcome. Our aim was to describe their profile, focusing on pharmacologic management in the ICU, time to return of awareness, and long-term prognosis. Methods: Adults with early LAS (defined as generalized myoclonus within 96 h, with epileptiform EEG within 48 h after CA) were retrospectively identified in our CA registry between 2006 and 2016. Functional outcome was assessed through cerebral performance categories (CPC) at 3 months, CPC 1–2 defined good outcome. Results: Among 458 consecutive patients, 7 (1.5%) developed early LAS (4 women, median age 59 years). Within 72 h after CA, in normothemia and off sedation, all showed preserved brainstem reflexes and localized pain. All patients were initially treated with valproate, levetiracetam and clonazepam; additional agents, including propofol and midazolam, were prescribed in the majority. First signs of awareness occurred after 3–23 days (median 11.8); 3/7 reached a good outcome at 3 months. Conclusion: Early after CA, myoclonus together with a reactive, epileptiform EEG, preserved evoked potentials and brainstem reflexes suggests LAS. This condition was managed with a combination of highly dosed, large spectrum antiepileptic agents including propofol and midazolam. Even if awakening was at times delayed, good outcome occurred in a substantial proportion of patients.