Action myoclonus (lance-adam syndrome) secondary to strangulation with dramatic response to alcohol
✍ Scribed by Shailendra Jain; Meena Jain
- Publisher
- John Wiley and Sons
- Year
- 1991
- Tongue
- English
- Weight
- 115 KB
- Volume
- 6
- Category
- Article
- ISSN
- 0885-3185
No coin nor oath required. For personal study only.
✦ Synopsis
To the Editor:
A 32-year-old man was accidentally strangled while operating a machine on January 29, 1989. He was brought to the hospital unconscious. After a week, he recovered but developed severe action myoclonus and an ataxic gait. Clonazepam, combined subsequently with sodium valproate, produced minimal improvement. Interestingly, after consumption of alcohol (30 ml of whiskey), the patient showed dramatic improvement (videotape segment).
Initially, 30 ml of whiskey (42% alcohol) three times a day was given to the patient. Surprisingly, 30 min after each dose of alcohol, he could manage daily routine activities. The effect of each dose lasted 4-6 h. Later, piracetam was added and produced improvement. Nevertheless, for a sustained, smooth, and prolonged benefit, additional alcohol was required.
Postanoxic action myoclonus was described by Lance and Adam in 1963 (1). Many cases have since been described secondary to anoxia, drug overdose, and mercury poisoning, etc. Action myoclonus has not previously been reported secondary to strangulation, although a late encephalopathy (2) has been described. Diazepam, phenobarbitone, clonazepam (3), sodium valproate, and 5- hydroxytryptophan (4) have been used in the management of this condition. The beneficial effect of alcohol has not previously been described.