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Intensive Care Med (2011) 37:177179DOI 10.1007/s00134-010-2055-6 CORRESPONDENCE
Marion Venot Nicolas Weiss Sophie Espinoza Audrey Imbert Jean-Marc Tadie Jean-Yves Fagon Emmanuel Guerot Jean-Luc Diehl
Improvement of early diagnosed post-anoxic myoclonuswith levetiracetam
Accepted: 26 July 2010Published online: 25 September 2010 Copyright jointly held by Springer and
ESICM 2010
Electronic supplementary materialThe online version of this article (doi:http://dx.doi.org/10.1007/s00134-010-2055-6
Web End =10.1007/s00134-010-2055-6 ) contains supplementary material, which is available to authorized users.
Dear Editor,Survivors of anoxic brain injury can develop post-anoxic myoclonus (PAM), also called Lance-Adams syndrome [13]. This condition appears to be quite rare, with fewer than 150 reported cases in literature [1], and was mainly described after cardiac arrest involving limited or absent no-ow or airway obstruction. Clinically, it presents as myoclonus, a rapid involuntary muscle jerking, which can occur spontaneously but is evident in action and is sensitive to external stimuli such as sudden sound. PAM is often diagnosed late after critical care discharge in the
rehabilitation department in patients with preserved mental function. In critical care, PAM can be falsely interpreted as myoclonic status epilepticus, which has been associated with poor outcome after cardiac arrest [4], even if some recent data show that some patients with preserved brainstem reactions can have better outcome [57]. Several treatment options have been previously proposed (valproic acid, clonazepam, primidone, piracetam) with, however, inconsistent results. Levetiracetam, which could inhibit glutamate transmission [8], has been proposed in only 12 patients in this condition but with apparently good and rapid response rate [2, 3].
We present two cases of PAM efciently treated with levetiracetam (Table 1). The rst one presented with cardiac arrest after vessel rupture during a coronary artery angiography, and the second one presented with cardiac arrest secondary to a massive pulmonary embolism. In both cases, there was no no-ow and low-ow was estimated at 15 min. The evolution in the critical care...