Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 20 , ISSUE 8 ( 2016 ) > List of Articles


Volatile anesthetic for the control of posthypoxic refractory myoclonic status

Vivek Rayadurg, Umamaheshwara Rao

Keywords : Hypoxia, isoflurane, Lance-Adams syndrome, myoclonus, refractory status epilepticus

Citation Information : Rayadurg V, Rao U. Volatile anesthetic for the control of posthypoxic refractory myoclonic status. Indian J Crit Care Med 2016; 20 (8):485-488.

DOI: 10.4103/0972-5229.188208

License: CC BY-ND 3.0

Published Online: 01-08-2016

Copyright Statement:  Copyright © 2016; The Author(s).


Posthypoxic myoclonus (Lance-Adams syndrome) is characterized by myoclonus involving multiple muscle groups which is resistant to most conventional antiepileptic drugs. We present a case of hypoxic brain injury-induced myoclonic status epilepticus successfully controlled with isoflurane. The antimyoclonic effects of isoflurane are likely due to potentiation of inhibitory postsynaptic GABA A receptor-mediated currents and its effects on thalamocortical pathways. It is effective even when intravenous agents fail to control myoclonus. It may be a useful alternative to intravenous anesthetics as a third tier therapy in patients with refractory status myoclonus.

PDF Share
  1. Wijdicks EF, Parisi JE, Sharbrough FW. Prognostic value of myoclonus status in comatose survivors of cardiac arrest. Ann Neurol 1994;35:239-43.
  2. Lance JW, Adams RD. The syndrome of intention or action myoclonus as a sequel to hypoxic encephalopathy. Brain 1963;86:111-36.
  3. Polesin A, Stern M. Post-anoxic myoclonus: A case presentation and review of management in the rehabilitation setting. Brain Inj 2006;20:213-7.
  4. Rollinson RD, Gilligan BS. Postanoxic action myoclonus (Lance-Adams syndrome) responding to valproate. Arch Neurol 1979;36:44-5.
  5. Terwinghe G, Daumerie J, Nicaise C, Rosillon O. Therapeutic effect of piracetam in a case of posthypoxic action myoclonus (author′s transl). Acta Neurol Belg 1978;78:30-6.
  6. Krauss GL, Bergin A, Kramer RE, Cho YW, Reich SG. Suppression of post-hypoxic and post-encephalitic myoclonus with levetiracetam. Neurology 2001;56:411-2.
  7. Galldiks N, Timmermann L, Fink GR, Burghaus L. Posthypoxic myoclonus (Lance-Adams syndrome) treated with lacosamide. Clin Neuropharmacol 2010;33:216-7.
  8. Ries CR, Puil E. Mechanism of anesthesia revealed by shunting actions of isoflurane on thalamocortical neurons. J Neurophysiol 1999;81:1795-801.
  9. Kofke WA, Young RS, Davis P, Woelfel SK, Gray L, Johnson D, et al. Isoflurane for refractory status epilepticus: A clinical series. Anesthesiology 1989;71:653-9.
  10. Mirsattari SM, Sharpe MD, Young GB. Treatment of refractory status epilepticus with inhalational anesthetic agents isoflurane and desflurane. Arch Neurol 2004;61:1254-9.
  11. Langmoen IA, Hegstad E, Berg-Johnsen J. An experimental study of the effect of isoflurane on epileptiform bursts. Epilepsy Res 1992;11:153-7.
  12. Patel PM, Drummond JC, Lemkuil BP. Cerebral physiology and the effects of anaesthetic drugs. In: Miller RD, editor. Miller′s Anaesthesia. 8 th ed. Philadelphia: Elsevier; 2015. p. 409.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.