A Case of The Successful Treatment of Pentobarbital for Posthypoxic Action Myoclonus(Lance-Adams Syndrome) with Refractory Status Epilepticus / 대한소아신경학회지

ABSTRACT

Lance-Adams syndrome is a rare complications of cardiorespiratory arrest. We report a 15-month-old child with Lance-Adams syndrome who fell into a refractory status epilepticus after a successful resuscitation after the cardiopulmonary arrest from upper airway obstruction due to the croup. On the day of the admission, he went through a generalized tonic-clonic seizure with poor mental status. His condition became aggravated on 18th day of admission when he developed focal myoclonus in his left arm and leg. The EEG findings before the pentobarbital treatment show partial electrical seizure. The seizures were intractable despite the administration of midazolam, phenobarbital, phenytoin, and valproic acid. Therefore, a pentobarbital(PTB) therapy was required. PTB administered by a continuous infusion pump at a loading dose of 5 mg/kg was sufficient to produce a burst suppression pattern and a seizure control, followed by a maintenance infusion of 0.5-1.5 mg/kg/hour. At that time, the brain MRI showed a diffuse distribution of high signal intensity and swelling in both basal ganglia, thalamus and the temporo-occipital area. The therapy continued for 10 days. Thereafter, PTB was gradually tapered after a minimum 48-hours of a seizure-free status. So we report a case with a brief review of related literature.