Figura 1. Registros electroencefalográficos durante la crisis generalizada. a) Inicio y final de la crisis tónica. Se observa artefacto de músculo; b) Detalle del período del recuadro de a) en donde se puede evidenciar un patrón ictal delta generalizado; c) Al final de la crisis se observa una importante pérdida de actividad cerebral.
Figura 2. Registros electroencefalográficos durante dos episodios de mioclonías. Se observa el movimiento del miembro superior izquierdo (último canal) y, en el registro, únicamente artefacto de músculo y movimiento.
Response to perampanel in a patient with chronic post-hypoxic myoclonus
Introduction. Chronic post-hypoxic myoclonus is a condition in which the predominant clinical picture is myoclonus following hypoxic brain damage, usually due to cardiorespiratory arrest. It is a condition that is usually treated with antiepileptic drugs, in most cases with a modest clinical response.
Case report. We report the case of a patient who started with jerking movements, compatible with myoclonus in the four limbs and the face the day after recovering from a cardiorespiratory arrest. An electroencephalogram was performed during which the myoclonias were recorded with no electrical correlates. During admission, and in successive visits after discharge, different antiepileptic treatments were tried for the myoclonias, which were refractory and affected the patient’s quality of life. Two years after onset, treatment with perampanel up to a dose of 4 mg was initiated and the patient reported a significant clinical improvement, as evidenced in the visits.
Conclusions. Perampanel may be an effective alternative for the treatment of myoclonias in patients with chronic post-hypoxic myoclonus.
Key words. Cardiorrespiratory arrest. Gait disturbance. Lance-Adams syndrome. Perampanel. Posthypoxic chronic myoclonus. Refractory myoclonus.