Post-hypoxic myoclonus (PHM) and Lance–Adams syndrome (LAS) are rare conditions following cardiopulmonary resuscitation. The aim of this study was to identify functional activity in the cerebral cortex after a hypoxic event and to investigate alterations that could be modulated by deep brain stimulation (DBS). A voxel-based subtraction analysis of serial positron emission tomography (PET) scans was performed in a 34-year-old woman with chronic medically refractory PHM that improved with bilateral globus pallidus internus (Gpi) DBS implanted three years after the hypoxic event. The patient required low-frequency stimulation to show myoclonus improvement. Using voxel-based statistical parametric mapping, we identified a decrease in glucose metabolism in the prefrontal lobe including the dorsolateral, orbito-, and inferior prefrontal cortex, which was suspected to be the origin of the myoclonus from postoperative PET/magnetic resonance imaging (MRI) after DBS. Based on the present study results, voxel-based subtraction of PET appears to be a useful approach for monitoring patients with PHM treated with DBS. Further investigation and continuous follow-up on the use of PET analysis and DBS treatment for patients with PHM are necessary to help understanding the pathophysiology of PHM, or LAS.

中文翻译：

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缺氧后皮质肌阵挛的低频双边球状苍白球间质深脑刺激后的功能神经变化：基于正电子发射的基于体素的减法分析

低氧后肌阵挛（PHM）和兰斯-亚当斯综合征（LAS）是心肺复苏后的罕见情况。这项研究的目的是确定缺氧事件后大脑皮质的功能活动，并研究深部脑刺激（DBS）可以调节的变化。对一名34岁患有慢性难治性PHM的女性进行了基于正电子发射断层扫描（PET）扫描的基于体素的减法分析，该患者在缺氧事件发生三年后植入了双侧苍白球内翻（Gpi）DBS得以改善。该患者需要低频刺激以显示肌阵挛改善。使用基于体素的统计参数映射，我们发现前额叶（包括背外侧，眶和下额前皮层）的葡萄糖代谢下降，怀疑是DBS术后的PET /磁共振成像（MRI）引起的肌阵挛的起源。根据目前的研究结果，基于体素的PET减影似乎是监测DBS治疗的PHM患者的有用方法。有必要对PHM患者使用PET分析和DBS治疗进行进一步调查和持续随访，以帮助了解PHM或LAS的病理生理。