The objectives of this study are to describe treatment regimens for Lance Adams Syndrome and establish association with positive long-term clinical outcomes.

Lance-Adams syndrome (LAS) is a rare neurological complication following cardiopulmonary resuscitation. Patients present with action myoclonus within weeks to months after awakening which can be associated with significant morbidity. There is no established first line treatment.

We performed a retrospective chart review via an existing institutional database at Mayo Clinic to identify patients with LAS. Demographic data, diagnostic studies, treatments, and long-term clinical outcomes were extracted. Descriptive statistics were completed to highlight relationships between treatments and positive long-term clinical outcomes.   

Thirty nine patients met criteria for inclusion in our study. The most common initial treatment was levetiracetam (72%) followed by valproic acid (13%). Most patients initially treated with levetiracetam (86%) or valproic acid (88%) experienced improvement of symptoms. The majority of patients (72%) required a second medication for management, with the most common medications utilized being benzodiazepines (41%). Thirty-three patients (85%) had an improvement in symptoms over time and 31 patients (80%) had symptom control allowing for completion of basic skills independently. The average time to diagnosis was 104 days. The average duration to symptom control was 420 days. Seventeen patients (44 %) required one medication and another 17 patients (44%) required two medications to achieve symptom control. Thirteen patients (36 %) were ultimately able to successfully wean off medications.

Levetiracetam and valproic acid were the most common initial agents utilized for LAS, with benzodiazepines often being used as second line agents. Most patients experienced improvement of symptoms over time with some patients able to wean off of medications entirely.