Lance-Adams Syndrome : Functional Rehabilitation Via Multidisciplinary intervention
Bibliographic record
Abstract
LANCE-ADAMS SYNDROME: FUNCTIONAL REHABILITATION VIA MULTIDISCIPLINARY INTERVENTIONDerek Thong*, Bonnie Buchko^, Rouaa Mandurah*, Flor Muniz-Rodriguez*^, Seyed-Hossein Hosseini*^, Gihan Perera*^, Zhihui (Joy) Deng*^*McMaster University Department of Medicine, Division of PMR, Hamilton, Canada, ^Hamilton Health Sciences, Hamilton, CanadaLance-Adams syndrome (LAS), a chronic form of post-hypoxic myoclonus, is a rare complication developed days or weeks after a successful cardiopulmonary resuscitation. The characteristic features of this condition are action and reflex myoclonus that subside at rest. The myoclonus can produce marked functional disability and it especially interferes with gait, which can be bouncy and unsteady, resulting in falls and close-calls. The pathophysiology of LAS is not clear. The imaging studies of LAS patients indicated a heterogeneous mechanism with the involvement of cortical-subcortical structures, brainstem, and/or cerebellum. The current literature suggests that the most effective agents - levetiracetam, piracetam, clonazepam, and valproic acid - produce the best outcomes when used in any combination, except for levetiracetam and piracetam when used together. Despite there being approximately 150 case reports, there appears to be a paucity regarding functional outcomes after multidisciplinary treatment. In addition to myoclonus, most patients with LAS present with neurocognitive and communication impairments, which also impact the patientsu2019 functional ability.Our group at Hamilton Health Sciences represents a multidisciplinary team who specialize in the inpatient rehabilitation of acquired brain injury (ABI) and includes: physiatrists, neurologists, physiotherapists, pharmacists, psychiatrists, neuropsychologists, nurses, occupational therapists, speech language pathologists, therapeutic recreationists, social workers, and registered dieticians. We present three cases of LAS admitted between 2015 and 2018 that received multidisciplinary assessment and therapy at our ABI rehabilitation program. These patients were treated with a variety of pharmacologic and non-pharmacologic interventions.The multidisciplinary approach appears to result in marked functional gains for the three patients affected by LAS leading to an increase in independence and quality of life. The physical therapy and occupational therapy strategies seem to dictate the rate of functional progress while medications are responsible for the control of myoclonus per se. However, the patient's ability and willingness to participate in therapy and trialling medications is the main determinant of functional change at discharge.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".