The AAO Journal, 2023/06, 33(2):11. doi: 10.53702/2375-5717-33.2.10, type of study: ,cr,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

Full text    (https://meridian.allenpress.com/aaoj/article/33/2/10/493538/LBORC-NUFA-Poster-Abstracts-2023-Residents)

Keywords:

brain injury [27]
cardiac arrest [1]
case report [736]
intractable myoclonus [1]
Lance-Adams syndrome [1]
male [860]
OMT [3924]
osteopathic manipulative treatment [3945]

Abstract:

Introduction/Background: Symptomatic myoclonus after cardiac arrest secondary to post hypoxic brain injury is referred to as Lance-Adams syndrome (LAS). It is a rare complication of anoxic brain injury post cardiopulmonary resuscitation, with less than 200 reported cases to date and no found use of OMT on these patients. Case: A man in his 40’s was admitted to ICU after cardiopulmonary arrest following unsuccessful attempt of tracheostomy tube exchange. Past medical history include tracheal stenosis post tracheostomy, ESRD on hemodialysis, previous stroke, and heart failure The patient exhibited seizure-like activity with myoclonus on initial presentation, with CT,MRI head, and continuous EEG negative for acute intracranial pathology. The MRI head showed chronic bilateral striatocapsular and thalamic lacunar infarcts. The patient was initially treated with levetiracetam and later transitioned to Depakote and Clonazepam due to persistent myoclonus, which resulted in severe restriction of activities of daily living. Upon consultation with the OMM team, the patient was treated with various cranial, visceral and soft tissue techniques focusing on cranio-sacral dysfunction, and autonomic nervous system balancing. Result: A decrease in myoclonus severity and frequency was observed and documented after a total of 8 OMT sessions. The patient was eventually discharged at a state where he is able to perform basic functions with minimal assistance. Discussion: This case illustrates the benefits of OMT for myoclonus related to acute hypoxic brain injury, refractory to standard of care. Limitations include no post treatment follow up of the patient’s function, and lack of objective measurement of the myoclonus.