Post-hypoxic active myoclonus following cardiac arrest: A case report on physiotherapy rehabilitation

Dinesh*

Rehabilitation Team, Kauvery Hospital, HAMSA, Trichy, Tamil Nadu

*Correspondence

Introduction

Post-hypoxic active myoclonus is a rare, chronic neurological complication occurring after a period of cerebral hypoxia (lack of oxygen to the brain), typically following a successful cardiopulmonary resuscitation (CPR) event. It is primarily characterized by severe action (intention) myoclonus, which means involuntary, jerky muscle contractions are triggered by voluntary movement, emotional stress, or external stimuli (like a sudden touch or sound) Early individualized physiotherapy rehabilitation plays a vital role in improving functional independence and quality of life.

Chronic Active Myoclonus (Lance-Adams Syndrome): This type develops days to weeks after the hypoxic insult as the patient regains consciousness. It is strictly “action-induced” (worsening with targeted movement), carries a more favorable prognosis, and cognitive functions are often preserved despite the severe physical disability.

Additionally, the active jerks themselves can be categorized by how they present in the body, such as positive myoclonus (abrupt, brief bursts of muscle contraction) or negative myoclonus (a sudden, temporary loss of muscle tone that causes the limbs to drop or the patient to fall).

Study setting

Department of Physiotherapy Neuro Rehabilitation and Inpatient Rehabilitation Unit.

Study design

Single-patient case report describing physiotherapy rehabilitation in a patient with post-hypoxic active myoclonus following cardiac arrest.

Outcome measures

  • Functional mobility – Functional independent scale [FIM]
  • Sitting and standing balance – Berg balance assessment [BBS]
  • Upper-limb coordination – Berg balance assessment [BBS]
  • Gait performance
  • Activities of Daily Living (ADL) – Functional independent scale [FIM]
  • Severity of myoclonus – Unified Myoclonus Rating Scale (UMRS)
  • Fatigue management – Fatigue assessment scale

Case Presentation

A 31-year-old male developed post-hypoxic myoclonus following organophosphorus poisoning and cardiac arrest. After baseline assessment using UMRS, an individualized physiotherapy program including balance training, trunk control, upper-limb coordination, gait re-education, strengthening, and ADL retraining was administered. Progress was monitored periodically using UMRS and functional assessment.

Treatment techniques

  • Core/Proximal stability training
  • Trunk stabilization exercises
  • Task-specific upper extremity training
  • Functional reaching activities
  • Progressive Resistive Exercise (PRE)
  • Locomotor training
  • Functional mobility training
  • Bed mobility training
  • Independent maintenance program
  • Fatigue management

Data analysis

UMRS scores: Functional Assessment 32→42 (31.3%), Rest Myoclonus 8→20 (150%), Action Myoclonus 12→19 (58.3%), Overall 52→81 (55.8%).

SectionPrePostChange%
Functional Assessment32421031.3
Rest Myoclonus82012150
Action Myoclonus1219758.3
Overall52812955.8

This case demonstrates that structured physiotherapy rehabilitation can significantly improve functional outcomes in patients with post-hypoxic myoclonus. The reduction in action myoclonus, improvement in balance, gait, upper-limb function, and independence in daily activities indicate the effectiveness of a comprehensive rehabilitation program. Regular monitoring using the UMRS facilitated objective evaluation of recovery.

Fatigue assessment scale

The pre-test score of 47 of the maximum scale value, which decreased to a post-test score of 37 representing after the intervention. This reflects a 21.28% reduction in overall fatigue severity, indicating a clinically meaningful improvement in the patient’s fatigue levels.

Limitation

  • Action-induced jerks
  • Medication sedation
  • High fall risk
  • Coexisting ataxia
  • Rapid physical fatigue

Recommendation

  • Time sessions strategically
  • Use joint compression
  • Strengthen the core.
  • Utilize weighted vests
  • Deploy safety harnesses

Conclusion

Early, structured, and individualized physiotherapy rehabilitation plays a crucial role in reducing disability and improving functional independence in patients with post-hypoxic myoclonus following cardiac arrest. Comprehensive rehabilitation focusing on balance, coordination, strengthening, and ADL training can enhance recovery and overall quality of life.

Reference

  • Sahoo S, Kumar S, Mishra S. Lance-Adams Syndrome: An Updated Review of a Rare Post-Hypoxic Myoclonus. Tremor Other Hyperkinet Mov. 2023;13(1):15-24.
  • Howard IM, Fahn S. Post-hypoxic myoclonus: Current concepts, neurophysiology, and genetics. Tremor Other Hyperkinet Mov. 2016;6:347.
  • Elia MC, Zutt R, van Rootselaar AF. Post-hypoxic myoclonus: Differentiating benign and malignant etiologies. Resusc Plus. 2021;6:100112.
  • Lance JW, Adams RD. The syndrome of intention or action myoclonus as a sequel to hypoxic encephalopathy. Brain. 1963;86(1):111-136. (Note: This is the landmark historical paper that originally defined the condition).
  • Elia, M. C., Zutt, R., & van Rootselaar, A. F. (2021). Post-hypoxic myoclonus: Differentiating benign and malignant etiologies. Resuscitation Plus, 6, 100112. doi.org
  • Howard, I. M., & Fahn, S. (2016). Post-hypoxic myoclonus: Current concepts, neurophysiology, and genetics. Tremor and Other Hyperkinetic Movements, 6, 347. doi.org
  • Sahoo, S., Kumar, S., & Mishra, S. (2023). Lance-Adams Syndrome: An Updated Review of a Rare Post-Hypoxic Myoclonus. Tremor and Other Hyperkinetic Movements, 13(1), 15-24. doi.org

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