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Ramos RW, Viñas LL, Martín ER, Cárdenas CL, Pereda AF, Manzanares LL. Propriospinal myoclonus: diagnostic value of polymyography and video polysomnography. J Clin Sleep Med 2023; 19:995-998. [PMID: 36710433 PMCID: PMC10152362 DOI: 10.5664/jcsm.10486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/20/2022] [Accepted: 12/20/2022] [Indexed: 01/31/2023]
Abstract
Propriospinal myoclonus is a hyperkinetic movement disorder characterized by painless jerks of the axial muscles, mainly in the trunk and hips. A 53-year-old woman was referred to the Sleep Unit with trunk flexion movements in the supine position during the wake-sleep transition and during sleep, with premonitory sensation. We performed 2 video polysomnographic recordings. In the first video polysomnogram, the recording showed jerks of the trunk and abdomen that appeared when the posterior dominant alpha rhythm disappeared; during these jerks the patient stayed at stage 1 or stage 2 of non-rapid eye movement sleep. The second video polysomnogram included several electromyogram electrodes located at the masseter, deltoid, rectus abdominis (T9-T0 level), vastus lateralis, and tibialis anterior muscles. This polysomnogram revealed 123 repetitive arrhythmic jerks with variable duration, usually lasting 500-1,900 ms each (906 ± 0.4 ms). In our patient, propriospinal myoclonus was detected up to stage 2 of non-rapid eye movement sleep and even at rapid eye movement sleep. CITATION Ramos RW, Viñas LL, Martín ER, Cárdenas CL, Pereda AF, Manzanares LL. Propriospinal myoclonus: diagnostic value of polymyography and video polysomnography. J Clin Sleep Med. 2023;19(5):995-998.
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Affiliation(s)
- Rybel Wix Ramos
- Department of Clinical Neurophysiology, Sleep Unit, University Hospital “La Princesa”, Madrid, Spain
- Department of Neurology, Sleep unit, University Hospital “HM Puerta del Sur”, Móstoles, Spain
- Department of Neurology, Sleep Unit, University Hospital “HM Sanchinarro”, Madrid, Spain
| | - Laura López Viñas
- Clinical Neurophysiology. University Hospital “Fundación Jiménez Díaz”, Madrid, Spain
| | - Esmeralda Rocio Martín
- Department of Clinical Neurophysiology, Sleep Unit, University Hospital “La Princesa”, Madrid, Spain
| | - Cecilia Luque Cárdenas
- Department of Clinical Neurophysiology, Sleep Unit, University Hospital “La Princesa”, Madrid, Spain
| | - Adela Fraile Pereda
- Department of Neurology, Sleep unit, University Hospital “HM Puerta del Sur”, Móstoles, Spain
| | - Lydia López Manzanares
- Department of Neurology, Movement disorders unit, University Hospital “La Princesa”, Madrid, Spain
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Yun G, Kim E, Do W, Jung YH, Lee HJ, Kim Y. Transient involuntary movement disorder after spinal anesthesia: A case report. World J Clin Cases 2021; 9:7917-7922. [PMID: 34621846 PMCID: PMC8462229 DOI: 10.12998/wjcc.v9.i26.7917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/28/2021] [Accepted: 07/26/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Spinal anesthesia is commonly used for various surgeries. While many complications occur after induction of spinal anesthesia, involuntary movement is an extremely rare complication.
CASE SUMMARY Herein, we report the case of a 54-year-old healthy male patient who experienced involuntary movements after intrathecal injection of local anesthetics. This patient had undergone metal implant removal surgery in both the lower extremities; 7 h after intrathecal hyperbaric bupivacaine administration, involuntary raising of the left leg began to occur every 2 min. When the movement disorder appeared, the patient was conscious and cooperative. No other specific symptoms were noted in the physical examination conducted immediately after the involuntary leg raising started; moreover, the patient's motor and sensory assessments were normal. The symptom gradually subsided. Twelve hours after the symptom first occurred, its frequency decreased to approximately once every three hours. Two days postoperatively, the symptoms had completely disappeared without intervention.
CONCLUSION Anesthesiologists should be aware that movement disorders can occur after spinal anesthesia and be able to identify the cause, such as electrolyte imbalance or epilepsy, since immediate action may be required for treatment. Furthermore, it is crucial to know that involuntary movement that develop following spinal anesthesia is mostly self-limiting and may not require additional costly examinations.
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Affiliation(s)
- Giyoung Yun
- Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
- Department of Anesthesia and Pain Medicine, Pusan National University, School of Medicine, Yangsan 50612, South Korea
| | - Eunsoo Kim
- Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
- Department of Anesthesia and Pain Medicine, Pusan National University, School of Medicine, Yangsan 50612, South Korea
| | - Wangseok Do
- Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
| | - Young-Hoon Jung
- Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
| | - Hyun-Ju Lee
- Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
| | - Yesul Kim
- Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
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Kuvvet Yoldaş T, Yoldaş M, İşler D. Sistoskopi olgusunda uygulanan spinal anestezi sonrası gelişen spinal miyoklonus. EGE TIP DERGISI 2019. [DOI: 10.19161/etd.415976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Shiratori T, Hotta K, Satoh M. Spinal myoclonus following neuraxial anesthesia: a literature review. J Anesth 2019; 33:140-147. [PMID: 30613902 DOI: 10.1007/s00540-018-02607-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 12/26/2018] [Indexed: 02/07/2023]
Abstract
Spinal myoclonus (SM) is a rare neurologic movement disorder following neuraxial anesthesia (NA). SM following NA (SM-NA) has insufficient clinical information and its pathogenesis remains to be elucidated. The aim of this review article was to summarize the past cases and consider SM-NA pathophysiology. Based on our PubMed search, it was revealed that SM-NA develops within several hours after neuraxial local anesthetic (LA) administration and resolves in a day without leaving neurologic compilations. It occurs primarily in the lower extremities, but can sometimes spread upward and affect the upper extremities and trunk. Although statistical adjustments are indispensable, analysis of the previous cases provided important facts that seem to be related with the mechanism of SM-NA. The frequently used LAs for spinal anesthesia were hyperbaric. SM-NA occurrence was more frequent in women. After initiation of spinal anesthesia, intrathecal hyperbaric LA distributes cephalad. In the LA elimination process, the large concentration differences in intrathecal LA may induce the partially functioning spinal neurons, resulting in myoclonus generation. The morphological features of the lumbar spine in women can predispose to a higher LA concentration difference. SM-NA is an unpredictable and rare neural complication following NA and should be confirmed by basic experiments and large-scale researches.
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Affiliation(s)
- Tohru Shiratori
- Department of Anesthesiology, Ina Central Hospital, 1313-1 Koshiroukubo, Ina, Nagano, 396-8555, Japan.
| | - Kunihisa Hotta
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Masaaki Satoh
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
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Kang HY, Lee SW, Hong EP, Sim YH, Lee SM, Park SW, Kang JM. Myoclonus-like involuntary movements following cesarean delivery epidural anesthesia. J Clin Anesth 2016; 34:392-4. [PMID: 27687419 DOI: 10.1016/j.jclinane.2016.05.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 04/29/2016] [Accepted: 05/02/2016] [Indexed: 12/18/2022]
Abstract
Spinal myoclonus following neuraxial anesthesia is rare. This report describes a case of myoclonus-like involuntary movement that occurred during the recovery from epidural anesthesia for a cesarean delivery. The patient's symptom improved with the administration of benzodiazepine, and the patient recovered with no neurological sequelae. In conclusion, epidural anesthesia can cause spinal myoclonus, which can be treated with a benzodiazepine.
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Affiliation(s)
- Hee Yong Kang
- Department of Anesthesiology and Pain Medicine, Graduate School, Kyung Hee University
| | - Sang Wook Lee
- Department of Anesthesiology and Pain Medicine, Graduate School, Kyung Hee University
| | - Eun Pyo Hong
- Department of Anesthesia and Pain Medicine, Kyung Hee University Hospital
| | - Yeo Hae Sim
- Department of Anesthesia and Pain Medicine, Kyung Hee University Hospital
| | - Su-Mi Lee
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital at Gangdong
| | - Sung Wook Park
- Department of Anesthesiology and Pain Medicine, Graduate School, Kyung Hee University; Department of Anesthesia and Pain Medicine, Kyung Hee University Hospital
| | - Jong-Man Kang
- Department of Anesthesiology and Pain Medicine, Graduate School, Kyung Hee University; Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital at Gangdong.
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Nakamoto T, Hirota K, Iwai T, Shingu K. Complete resolution of myoclonus-like involuntary movements under subarachnoid block after midazolam administration in a patient undergoing cesarean section: a case report. Korean J Anesthesiol 2015; 68:193-5. [PMID: 25844141 PMCID: PMC4384410 DOI: 10.4097/kjae.2015.68.2.193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 03/18/2014] [Accepted: 03/24/2014] [Indexed: 12/17/2022] Open
Abstract
Involuntary movement during and after neuraxial anesthesia, such as spinal and epidural anesthesia, is rarely observed. In this report, we describe a case of myoclonus-like involuntary movement of the upper extremities in a patient undergoing a planned repeat cesarean section under spinal anesthesia with bupivacaine that completely subsided after administration of 2 mg of midazolam. The myoclonus-like movement did not recur or cause any apparent neurological side effects.
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Affiliation(s)
- Takahiro Nakamoto
- Department of Anesthesiology, Kansai Medical University, Hirakata, Japan
| | - Kiichi Hirota
- Department of Anesthesiology, Kansai Medical University, Hirakata, Japan
| | - Teppei Iwai
- Department of Anesthesiology, Kansai Medical University, Hirakata, Japan
| | - Koh Shingu
- Department of Anesthesiology, Kansai Medical University, Hirakata, Japan
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Ji TT, Shih CK, Hsieh YJ, Sun WZ. Desultory propriospinal myoclonus after epidural analgesia in a healthy parturient. Int J Obstet Anesth 2015; 24:285-6. [PMID: 25840854 DOI: 10.1016/j.ijoa.2015.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 02/05/2015] [Accepted: 02/22/2015] [Indexed: 12/24/2022]
Affiliation(s)
- T T Ji
- Department of Anesthesia, Changhua Christian Hospital, Taiwan
| | - C K Shih
- Department of Anesthesia, Changhua Christian Hospital, Taiwan
| | - Y J Hsieh
- Department of Anesthesia, Changhua Christian Hospital, Taiwan.
| | - W Z Sun
- Department of Anesthesia, National Taiwan University Hospital, Taiwan
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