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.
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.
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.
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.
Galldiks N, Timmermann L, Fink GR, Burghaus L. Posthypoxic myoclonus (Lance-Adams syndrome) treated with lacosamide. Clin Neuropharmacol 2010;33:216-7.
Ries CR, Puil E. Mechanism of anesthesia revealed by shunting actions of isoflurane on thalamocortical neurons. J Neurophysiol 1999;81:1795-801.
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.
Mirsattari SM, Sharpe MD, Young GB. Treatment of refractory status epilepticus with inhalational anesthetic agents isoflurane and desflurane. Arch Neurol 2004;61:1254-9.
Langmoen IA, Hegstad E, Berg-Johnsen J. An experimental study of the effect of isoflurane on epileptiform bursts. Epilepsy Res 1992;11:153-7.
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.