[Myoclonus in the adult: diagnostic approach]

Ongoing abdominal status myoclonus in postanoxic coma

We present the video of a patient who presented massive and ongoing rhythmic abdominal myoclonus in postanoxic coma.

Myoclonus and movement disorders

Myoclonus is a movement disorder characterized by the occurrence of an involuntary abrupt muscle contraction causing a sudden unexpected jerk. Many other movement disorders can present with the same jerky, shock-like appearance. This paper reviews the clinical and neurophysiologic arguments supporting the distinction between true myoclonus and various imitators, including chorea, ballism, tics, dystonia, stereotypy, tremor and restless limbs. To be differentiated from myoclonus, these movement disorders, despite their heterogeneity, are distinctive through the patterned profile of muscle activation, the longer duration of the muscle contraction, the conditions in which they occur, and their suppressibility at will.

Intérêt et limites de l’examen polymyographique dans l’étude des dystonies

INTRODUCTION

Diagnosis of dystonia is based on well-known clinical findings, but electrophysiological explorations can help to establish the diagnosis.

METHODS

We report 179 patients presenting primary or secondary dystonia. Polymyographic recordings were available for all. We studied activation patterns of agonist and antagonists muscles (prolonged bursts, co-contraction), presence of antagonistic gestures and other associated movement disorders such as tremor or myoclonus.

RESULTS

83.9 percent of patients presented abnormalities which evoked dystonia (prolonged bursts: 75.3 percent, co-contraction: 48.7 percent, successful antagonistic gesture successful with reduction or suppression of EMG activity, 8.7 percent). For the patients who presented no EMG abnormality, diagnosis was maintained in 22 cases because of the limitations of the exploration: intermittent symptoms, dystonia involving deep muscles which were not recorded by the surface electromyogram, or difficulties to reproduce the conditions of apparition of the dystonic symptoms during examination or to recognize a pathologic EMG pattern in hand cramps for instance. Another diagnosis was retained because of the polymyographic findings in 16.2 p.cent of these patients, particularly those who had tremor associated with dystonia (essentially diagnosis of primary writing tremor).

CONCLUSION

Polymyography is an effective tool for confirming clinical findings.

[Palatal myoclonus and dysphagia]

INTRODUCTION

Post brainstem lesion dysphagia is frequently associated with palatal myoclonus (PM) but the correlation between these two symptoms is still unclear.

OBJECTIVE

The aim of this study was to verify the relationship between PM and dysphagia, and if PM could itself induce dysphagia.

PATIENTS AND METHODS

Twelve patients suffering from post brainstem lesion PM and dysphagia; 10 male and two female, mean aged of 50.5 years, were assessed using clinical examination, radiological and endoscopic examination of deglutition.

RESULTS

In three cases, PM were associated with pharyngeal area decreasing, laryngeal aspiration, and dysphagia.

DISCUSSION

This study confirms the hypothesis of close relationship between PM and dysphagia. In these cases, specific dysphagia therapy should be recommended.

CONCLUSION

Post brainstem lesion dysphagia is sometimes associated with PM and in some cases, there is probably a relationship between PM and swallowing disorders of these patients.