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Olbert E, Alhani N, Struhal W. Retrospective analysis of COVID-19 patients with Guillain-Barre, Miller-Fisher, and opsoclonus-myoclonus-ataxia syndromes-a case series. Wien Med Wochenschr 2024; 174:30-34. [PMID: 37523107 PMCID: PMC10810910 DOI: 10.1007/s10354-023-01018-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/23/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND In accordance with the rising number of SARS-CoV‑2 infections, reports of neurological complications have also increased. They include cerebrovascular diseases but also immunological diseases such as Guillain-Barre syndrome (GBS), Miller-Fisher syndrome (MFS), and opsoclonus-myoclonus-ataxia syndrome (OMAS). While GBS and MFS are typical postinfectious complications, OMAS has only recently been described in the context of COVID-19. GBS, MFS, and OMAS can occur as para- and postinfectious, with different underlying pathomechanisms depending on the time of neurological symptom onset. The study aimed to describe clinical features, time between infection and onset of neurological symptoms, and outcome for these diseases. METHODS All COVID-19 patients treated in the neurological ward between January 2020 and December 2022 were screened for GBS, MFS, and OMAS. The clinical features of all patients, with a particular focus on the time of onset of neurological symptoms, were analyzed. RESULTS This case series included 12 patients (7 GBS, 2 MFS, 3 OMAS). All GBS and one MFS patient received immunomodulatory treatment. Three patients (2 GBS, 1 OMAS) had a severe COVID-19 infection and received mechanical ventilation. In patients with OMAS, only one patient received treatment with intravenous immunoglobulin and cortisone. The remaining two patients, both with disease onset concurrent with SARS-COV‑2 infection, recovered swiftly without treatment. In all subgroups, patients with concurrent onset of neurological symptoms and COVID-19 infection showed a trend toward shorter disease duration. CONCLUSION All patient groups displayed a shorter disease duration if the onset of neurological symptoms occurred shortly after the COVID-19 diagnosis. In particular, both the OMAS patients with symptom onset concurrent with COVID-19 showed only abortive symptoms followed by a swift recovery. This observation would suggest different pathomechanisms for immune-mediated diseases depending on the time of onset after an infection.
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Affiliation(s)
- Elisabeth Olbert
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500, Krems, Austria.
- Department of Neurology, University Hospital Tulln, Alter Ziegelweg 10, 3430, Tulln an der Donau, Austria.
| | - Naela Alhani
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500, Krems, Austria
- Department of Neurology, University Hospital Tulln, Alter Ziegelweg 10, 3430, Tulln an der Donau, Austria
| | - Walter Struhal
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500, Krems, Austria
- Department of Neurology, University Hospital Tulln, Alter Ziegelweg 10, 3430, Tulln an der Donau, Austria
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Silverman A, Miglis MG, Gallentine W. Images: Benign myoclonus of sleep associated with K-complexes on electroencephalography. J Clin Sleep Med 2024; 20:183-184. [PMID: 37772703 PMCID: PMC10758558 DOI: 10.5664/jcsm.10822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/04/2023] [Accepted: 09/04/2023] [Indexed: 09/30/2023]
Abstract
In this brief case report on paroxysmal sleep-related movements, we describe an adolescent patient's presentation of brief jerking movements during sleep and the accompanying differential diagnosis. In examining the patient's overnight electroencephalogram we use hallmark sleep architecture to provide reassurance to the patient and her family. CITATION Silverman A, Miglis MG, Gallentine W. Images: Benign myoclonus of sleep associated with K-complexes on electroencephalography. J Clin Sleep Med. 2024;20(1):183-184.
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Affiliation(s)
- Andrew Silverman
- Division of Child Neurology, Stanford University School of Medicine, Stanford, California
- Department of Neurology, Stanford University School of Medicine, Stanford, California
| | - Mitchell G. Miglis
- Department of Neurology, Stanford University School of Medicine, Stanford, California
- Sleep Medicine Center, Stanford University School of Medicine, Stanford, California
| | - William Gallentine
- Division of Child Neurology, Stanford University School of Medicine, Stanford, California
- Department of Neurology, Stanford University School of Medicine, Stanford, California
- Pediatric Epilepsy Center, Stanford University School of Medicine, Stanford, California
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Zawar I, Shreshtha B, Benech D, Burgess RC, Bulacio J, Knight EMP. Electrographic Features of Epilepsy With Eyelid Myoclonia With Photoparoxysmal Responses. J Clin Neurophysiol 2024; 41:83-92. [PMID: 35394968 DOI: 10.1097/wnp.0000000000000942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Epilepsy with eyelid myoclonia (EMA) is characterized by eyelid myoclonia, eyelid closure sensitivity, and photosensitivity. EEG may manifest with frontal-predominant (FPEDs) or occipital-predominant epileptiform discharges (OPEDs). Data on clinical and electrographic features of these two subtypes are lacking. The purpose of our research was to look at baseline electroclinical features of EMA subtypes and to study electrographic findings of patients with EMA during intermittent photic stimulation (IPS). METHODS We retrospectively identified all patients who had photoparoxysmal responses on EEGs performed at Cleveland clinic between January 01, 2012, and December 31, 2019. Patients who met diagnostic criteria for EMA were studied further. RESULTS Of the 249 patients with photoparoxysmal responses, 70 (28.1%) had EMA (62 [88.6%] female; the mean age of epilepsy onset: 7.0 ± 7.9 years). Patients with EMA had either FPEDs or OPEDs. Eleven patients with EMA (15.7%) had seizures (4 absence, 5 myoclonic and 2 bilateral tonic-clonic) during IPS. Patients with OPEDs were more likely to have drug-resistant epilepsy; occipital focal IEDs and other focal IEDs (other than frontal/occipital) on baseline EEG; and generalized IEDs with occipital predominance, generalized IEDs with no predominance, or focal IEDs during IPS. Predictors of seizure occurrence during photic stimulation included the presence of focal occipital IEDs on baseline EEG, generalized IEDs with frontal predominance during IPS, and photoparoxysmal response outlasting the stimulus. CONCLUSIONS Our study provides evidence that EMA has two distinct subtypes, which differ in clinical characteristics, baseline EEG, and EEG during photic stimulation. We highlight diagnostic and prognostic implications of these findings. Our study also details EEG characteristics of patients with EMA during IPS.
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Affiliation(s)
- Ifrah Zawar
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.; and
- Department of Neurology, University of Virginia School of Medicine, Virginia, U.S.A
| | - Bijina Shreshtha
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.; and
| | - Daniela Benech
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.; and
| | - Richard C Burgess
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.; and
| | - Juan Bulacio
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.; and
| | - Elia M Pestana Knight
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.; and
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Wang F, Buchberger M, Böck K, Wirth M. Essential Palatal Myoclonus and Clicking Tinnitus in a Nine-Year-Old Boy-A Case Report. Laryngoscope 2024; 134:397-399. [PMID: 37161907 DOI: 10.1002/lary.30734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 02/22/2023] [Accepted: 04/01/2023] [Indexed: 05/11/2023]
Abstract
The work describes a case of palatal myoclonus with distressing tinnitus in a 9-year-old boy and its successful treatment with injections of botulinum toxin. This case report discusses common questions about myoclonic-induced clicking tinnitus and provides answers. Laryngoscope, 134:397-399, 2024.
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Affiliation(s)
- Fang Wang
- Department of Otorhinolaryngology/Head & Neck Surgery of the university hospital Klinikum rechts der Isar, The university hospital Klinikum rechts der Isar, Munich, Bayern, Germany
| | - Maria Buchberger
- Department of Otorhinolaryngology/Head & Neck Surgery of the university hospital Klinikum rechts der Isar, The university hospital Klinikum rechts der Isar, Munich, Bayern, Germany
| | - Katja Böck
- Department of Otorhinolaryngology/Head & Neck Surgery of the university hospital Klinikum rechts der Isar, The university hospital Klinikum rechts der Isar, Munich, Bayern, Germany
| | - Markus Wirth
- Department of Otorhinolaryngology/Head & Neck Surgery of the university hospital Klinikum rechts der Isar, The university hospital Klinikum rechts der Isar, Munich, Bayern, Germany
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Williams L, Waller SE, Bradley M, Lockhart A, Narayanan RK, Kumar KR, Morales Briceno H, Tchan M, Healy DG, Fung VSC. ATP1A3 related disease manifesting as rapid onset dystonia-parkinsonism with prominent myoclonus and exaggerated startle. Parkinsonism Relat Disord 2023; 117:105864. [PMID: 37827923 DOI: 10.1016/j.parkreldis.2023.105864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 10/14/2023]
Abstract
We report ATP1A3-associated rapid-onset dystonia-parkinsonism with an atypical presentation including myoclonus and exaggerated startle in four patients. Their prominence over parkinsonism prompted consideration of a syndromic diagnosis of myoclonus dystonia. ATP1α3 dysfunction in GABAergic neurons could explain these examination findings. The spectrum of ATP1A3-associated movement disorders includes myoclonus-dystonia.
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Affiliation(s)
- L Williams
- Movement Disorders Unit, Neurology Department, Westmead Hospital, Westmead, NSW, 2145, Australia.
| | - S E Waller
- Movement Disorders Unit, Neurology Department, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - M Bradley
- Department of Neurology, Beaumont Hospital, Beaumont, Dublin 9, Ireland
| | - A Lockhart
- Department of Neurology, Beaumont Hospital, Beaumont, Dublin 9, Ireland
| | - R K Narayanan
- Northcott Neuroscience Laboratory, ANZAC Research Institute, Concord, NSW, Australia; Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - K R Kumar
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Garvan Institute of Medical Research, Darlinghurst, NSW, Australia; Faculty of Medicine and Health, University of New South Wales, Australia; Molecular Medicine Laboratory and Neurology Department, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - H Morales Briceno
- Movement Disorders Unit, Neurology Department, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - M Tchan
- Department of Medical Genetics, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - D G Healy
- Department of Neurology, Beaumont Hospital, Beaumont, Dublin 9, Ireland
| | - V S C Fung
- Movement Disorders Unit, Neurology Department, Westmead Hospital, Westmead, NSW, 2145, Australia; Faculty of Medicine and Health, University of New South Wales, Australia
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Shpiner DS, Peabody TK, Luca CC, Jagid J, Moore H. Deep Brain Stimulation for an Unusual Presentation of Myoclonus Dystonia Associated with Russell-Silver Syndrome. Tremor Other Hyperkinet Mov (N Y) 2023; 13:40. [PMID: 37928887 PMCID: PMC10624206 DOI: 10.5334/tohm.782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/05/2023] [Indexed: 11/07/2023] Open
Abstract
Background Myoclonus dystonia syndrome typically results from autosomal dominant mutations in the epsilon-sarcoglycan gene (SGCE) via the paternally expressed allele on chromosome 7q21. There is evidence that deep brain stimulation (DBS) is beneficial for this genotype, however, there are few prior case reports on DBS for myoclonus dystonia syndrome secondary to other confirmed genetic etiologies. Case Report A 20-year-old female with concomitant Russell-Silver syndrome and myoclonus dystonia syndrome secondary to maternal uniparental disomy of chromosome 7 (mUPD7) presented for medically refractory symptoms. She underwent DBS surgery targeting the bilateral globus pallidus interna with positive effects that persisted 16 months post-procedure. Discussion We present a patient with the mUPD7 genotype for myoclonus dystonia syndrome who exhibited a similar, if not superior, response to DBS when compared to patients with other genotypes. Highlights This report outlines the first described case of successful deep brain stimulation treatment for a rare genetic variant of myoclonus dystonia syndrome caused by uniparental disomy at chromosome 7. These findings may expand treatment options for patients with similar conditions.
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Affiliation(s)
- Danielle S. Shpiner
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Taylor K. Peabody
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Corneliu C. Luca
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jonathan Jagid
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Henry Moore
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
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Yaqub A, Ikram MK, Blankevoort J, Ikram MA. Diagnostic challenge of Creutzfeldt-Jakob disease in a patient with multimorbidity: a case-report. BMC Neurol 2023; 23:346. [PMID: 37784069 PMCID: PMC10544493 DOI: 10.1186/s12883-023-03401-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 09/25/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Creutzfeldt-Jakob disease (CJD) is a rapidly progressive and ultimately fatal neurodegenerative condition caused by prions. The clinical symptoms of CJD vary with its subtype, and may include dementia, visual hallucinations, myoclonus, ataxia, (extra)pyramidal signs and akinetic mutism. In the early course of disease however, several clinical symptoms of CJD may mimic those of co-existing morbidities. CASE PRESENTATION We report a male in his 60s with a history of situs inversus totalis and Churg Strauss syndrome, who presented with speech fluency disturbances, neuropsychiatric symptoms and allodynia, a few months after becoming a widower. Initially presumed a bereavement disorder along with a flare-up of Churg Strauss, his symptoms gradually worsened with apraxia, myoclonic jerks and eventually, akinetic mutism. MRI revealed hyperintensities at the caudate nucleus and thalami, while the cerebrospinal fluid was positive for the 14-3-3 protein and the real-time quick test, making the diagnosis of CJD highly probable. This case illustrates the complexities that may arise in diagnosing CJD when pre-existing multimorbidity may cloud the clinical presentation. We also discuss the potential mechanisms underlying the co-occurrence of three rare conditions (situs inversus totalis, Churg Strauss syndrome, CJD) in one patient, taking into consideration the possibility of coincidence as well as common underlying factors. CONCLUSIONS The diagnosis of CJD may be easily missed when its clinical symptoms are obscured by those of pre-existing (rare) multimorbidity. This case highlights that when the multimorbidity has neurological manifestations, an extensive evaluation remains crucial to establish the diagnosis, minimize the risk of prion-transmission and provide appropriate guidance to patients and their caregivers.
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Affiliation(s)
- Amber Yaqub
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Mohammad Kamran Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Mohammad Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
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Fujii Y, Murata Y, Hokkoku K, Chiba T, Hamada Y, Uchibori A, Chiba A, Kobayashi S, Sonoo M. Anti-amphiphysin-positive Progressive Encephalomyelitis with Rigidity and Myoclonus. Can J Neurol Sci 2023; 50:781-783. [PMID: 36059101 DOI: 10.1017/cjn.2022.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Yuki Fujii
- Department of Neurology, Teikyo University School of Medicine, Tokyo, Japan
| | - Yuki Murata
- Department of General Medicine, Itabashi Chuo Medical Center, Japan
| | - Keiichi Hokkoku
- Department of Neurology, Teikyo University School of Medicine, Tokyo, Japan
| | - Takashi Chiba
- Department of Neurology, Teikyo University School of Medicine, Tokyo, Japan
| | - Yuichi Hamada
- Department of Neurology, Teikyo University School of Medicine, Tokyo, Japan
- Department of Neurology, Sumitomo Hospital, Osaka, Japan
| | - Ayumi Uchibori
- Department of Neurology, Kyorin University School of Medicine, Tokyo, Japan
| | - Atsuro Chiba
- Department of Neurology, Kyorin University School of Medicine, Tokyo, Japan
| | - Shunsuke Kobayashi
- Department of Neurology, Teikyo University School of Medicine, Tokyo, Japan
| | - Masahiro Sonoo
- Department of Neurology, Teikyo University School of Medicine, Tokyo, Japan
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9
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Ali AH, Benterud A, Holmøy T, Myro AZ. Progressive encephalomyelitis with rigidity and myoclonus (PERM) associated with anti-glycine receptor antibodies and urothelial carcinoma: a case report. J Med Case Rep 2023; 17:330. [PMID: 37533037 PMCID: PMC10399042 DOI: 10.1186/s13256-023-04059-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/24/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Progressive encephalomyelitis with rigidity and myoclonus (PERM) is a rare neurological condition with paraneoplastic etiology in about 20% of cases, usually presenting before or shortly after the oncological diagnosis is established. PERM associated with anti-glycine receptor antibodies is not previously reported in a patient with bladder cancer. CASE PRESENTATION A 72-years-old Caucasian male was admitted with acute onset of dysarthria, dysphagia and trismus three years after initial surgical treatment for bladder cancer. The condition was initially diagnosed as tetanus and treated accordingly, but the diagnosis was reconsidered because of progression despite adequate treatment. Diagnostic workup on readmission revealed lung and paraaortal metastases from bladder cancer and anti-glycine receptor (anti-GlyR) antibodies both in the cerebrospinal fluid and in serum, which supplemented with the clinical presentation led to the diagnosis of PERM, presumably related to bladder cancer. The patient showed improvement and stabilization after treatment with intravenous immunoglobulin and chemotherapy against metastatic bladder cancer. CONCLUSION To the best of our knowledge, this is the first reported case of anti-GlyR antibody positive PERM related to urothelial carcinoma. The symptoms mimicked tetanus, and responded to chemotherapy and immunotherapy.
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Affiliation(s)
- Amanuel Hassen Ali
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Anna Benterud
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Trygve Holmøy
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Aija Zuleron Myro
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
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10
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Shir D, Pham NTT, Botha H, Koga S, Kouri N, Ali F, Knopman DS, Petersen RC, Boeve BF, Kremers WK, Nguyen AT, Murray ME, Reichard RR, Dickson DW, Graff-Radford N, Josephs KA, Whitwell J, Graff-Radford J. Clinicoradiologic and Neuropathologic Evaluation of Corticobasal Syndrome. Neurology 2023; 101:e289-e299. [PMID: 37268436 PMCID: PMC10382268 DOI: 10.1212/wnl.0000000000207397] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/23/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Corticobasal syndrome (CBS) is a clinical phenotype characterized by asymmetric parkinsonism, rigidity, myoclonus, and apraxia. Originally believed secondary to corticobasal degeneration (CBD), mounting clinicopathologic studies have revealed heterogenous neuropathologies. The objectives of this study were to determine the pathologic heterogeneity of CBS, the clinicoradiologic findings associated with different underlying pathologies causing CBS, and the positive predictive value (PPV) of current diagnostic criteria for CBD among patients with a CBS. METHODS Clinical data, brain MRI, and neuropathologic data of patients followed at Mayo Clinic and diagnosed with CBS antemortem were reviewed according to neuropathology category at autopsy. RESULTS The cohort consisted of 113 patients with CBS, 61 (54%) female patients. Mean ± SD disease duration was 7 ± 3.7 years; mean ± SD age at death was 70.5 ± 9.1 years. The primary neuropathologic diagnoses were 43 (38%) CBD, 27 (24%) progressive supranuclear palsy (PSP), 17 (15%) Alzheimer disease (AD), 10 (9%) frontotemporal lobar degeneration (FTLD) with TAR DNA-binding protein 43 (TDP) inclusions, 7 (6%) diffuse Lewy body disease (DLBD)/AD, and 9 (8%) with other diagnoses. Patients with CBS-AD or CBS-DLBD/AD were youngest at death (median [interquartile range]: 64 [13], 64 [11] years) while CBS-PSP were oldest (77 [12.5] years, p = 0.024). Patients with CBS-DLBD/AD had the longest disease duration (9 [6] years), while CBS-other had the shortest (3 [4.25] years, p = 0.04). Posterior cortical signs and myoclonus were more characteristic of patients with CBS-AD and patients with CBS-DLBD/AD. Patients with CBS-DLBD/AD displayed more features of Lewy body dementia. Voxel-based morphometry revealed widespread cortical gray matter loss characteristic of CBS-AD, while CBS-CBD and CBS-PSP predominantly involved premotor regions with greater amount of white matter loss. Patients with CBS-DLBD/AD showed atrophy in a focal parieto-occipital region, and patients with CBS-FTLD-TDP had predominant prefrontal cortical loss. Patients with CBS-PSP had the lowest midbrain/pons ratio (p = 0.012). Of 67 cases meeting clinical criteria for possible CBD at presentation, 27 were pathology-proven CBD, yielding a PPV of 40%. DISCUSSION A variety of neurodegenerative disorders can be identified in patients with CBS, but clinical and regional imaging differences aid in predicting underlying neuropathology. PPV analysis of the current CBD diagnostic criteria revealed suboptimal performance. Biomarkers adequately sensitive and specific for CBD are needed.
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Affiliation(s)
- Dror Shir
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Nha Trang Thu Pham
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Hugo Botha
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Shunsuke Koga
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Naomi Kouri
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Farwa Ali
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - David S Knopman
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Ronald C Petersen
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Brad F Boeve
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Walter K Kremers
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Aivi T Nguyen
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Melissa E Murray
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - R Ross Reichard
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Dennis W Dickson
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Neill Graff-Radford
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL.
| | - Keith Anthony Josephs
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Jennifer Whitwell
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Jonathan Graff-Radford
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL.
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11
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van Noort SAM, van der Veen S, de Koning TJ, de Koning-Tijssen MAJ, Verbeek DS, Sival DA. Early onset ataxia with comorbid myoclonus and epilepsy: A disease spectrum with shared molecular pathways and cortico-thalamo-cerebellar network involvement. Eur J Paediatr Neurol 2023; 45:47-54. [PMID: 37301083 DOI: 10.1016/j.ejpn.2023.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/14/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Early onset ataxia (EOA) concerns a heterogeneous disease group, often presenting with other comorbid phenotypes such as myoclonus and epilepsy. Due to genetic and phenotypic heterogeneity, it can be difficult to identify the underlying gene defect from the clinical symptoms. The pathological mechanisms underlying comorbid EOA phenotypes remain largely unknown. The aim of this study is to investigate the key pathological mechanisms in EOA with myoclonus and/or epilepsy. METHODS For 154 EOA-genes we investigated (1) the associated phenotype (2) reported anatomical neuroimaging abnormalities, and (3) functionally enriched biological pathways through in silico analysis. We assessed the validity of our in silico results by outcome comparison to a clinical EOA-cohort (80 patients, 31 genes). RESULTS EOA associated gene mutations cause a spectrum of disorders, including myoclonic and epileptic phenotypes. Cerebellar imaging abnormalities were observed in 73-86% (cohort and in silico respectively) of EOA-genes independently of phenotypic comorbidity. EOA phenotypes with comorbid myoclonus and myoclonus/epilepsy were specifically associated with abnormalities in the cerebello-thalamo-cortical network. EOA, myoclonus and epilepsy genes shared enriched pathways involved in neurotransmission and neurodevelopment both in the in silico and clinical genes. EOA gene subgroups with myoclonus and epilepsy showed specific enrichment for lysosomal and lipid processes. CONCLUSIONS The investigated EOA phenotypes revealed predominantly cerebellar abnormalities, with thalamo-cortical abnormalities in the mixed phenotypes, suggesting anatomical network involvement in EOA pathogenesis. The studied phenotypes exhibit a shared biomolecular pathogenesis, with some specific phenotype-dependent pathways. Mutations in EOA, epilepsy and myoclonus associated genes can all cause heterogeneous ataxia phenotypes, which supports exome sequencing with a movement disorder panel over conventional single gene panel testing in the clinical setting.
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Affiliation(s)
- Suus A M van Noort
- Department of Paediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Pediatric Neurology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands; Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands
| | - Sterre van der Veen
- Department of Paediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands
| | - Tom J de Koning
- Department of Paediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Pediatrics, University Medical Center Groningen, Groningen, the Netherlands; Pediatrics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Marina A J de Koning-Tijssen
- Department of Paediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands
| | - Dineke S Verbeek
- Department of Paediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Genetics, University Medical Center Groningen, Groningen, the Netherlands
| | - Deborah A Sival
- Department of Paediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Pediatric Neurology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands.
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12
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Birkenbeuel JL, Tawk K, Martin EC, Abouzari M, Djalilian HR. Treatment of Stapedial Myoclonus as a Migraine-Related Phenomenon. Otol Neurotol 2023; 44:388-391. [PMID: 36843031 PMCID: PMC10049888 DOI: 10.1097/mao.0000000000003838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
OBJECTIVE To describe a case series of patients with stapedial myoclonus (SM) whose conditions improved after prophylactic migraine treatment. PATIENTS We present seven cases of SM reported from a tertiary care neurotology clinic. All seven patients reported SM triggers similar to those of migraine headaches and suffered from concomitant headaches and/or vertigo, and were thus treated with a standard migraine protocol used at this neurotology clinic. INTERVENTION Prophylactic migraine treatment. MAIN OUTCOME MEASURES Reduction or resolution of SM. RESULTS In this series, seven patients with SM were included. Six of seven subjects were male (86%), with a mean age at presentation of 44 years. Four patients noted significant improvement in their symptoms, with a reduced frequency, duration, and intensity of their symptoms with the migraine regimen. Three patients experienced complete resolution of SM with their migraine treatment. CONCLUSION We report that treatment with prophylactic migraine treatment can provide long-term relief for patients with SM, which may suggest an etiological association between migraine and SM as well as a possible treatment for SM.
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Affiliation(s)
- Jack L. Birkenbeuel
- Department of Otolaryngology – Head and Neck Surgery, University of California, Irvine, USA
| | - Karen Tawk
- Department of Otolaryngology – Head and Neck Surgery, University of California, Irvine, USA
| | - Elaine C. Martin
- Department of Otolaryngology – Head and Neck Surgery, University of California, Irvine, USA
| | - Mehdi Abouzari
- Department of Otolaryngology – Head and Neck Surgery, University of California, Irvine, USA
| | - Hamid R. Djalilian
- Department of Otolaryngology – Head and Neck Surgery, University of California, Irvine, USA
- Department of Biomedical Engineering, University of California, Irvine, USA
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13
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Elzomor H, El Menawi S, Elawady H, Elkinaai N, Elshafie M, Refaat A, Ghareeb H, Fawzy M. Neuroblastoma-associated Opsoclonous Myoclonous Ataxia Syndrome: Profile and Outcome Report on 15 Egyptian Patients. J Pediatr Hematol Oncol 2023; 45:e194-e199. [PMID: 35462382 DOI: 10.1097/mph.0000000000002466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 03/08/2022] [Indexed: 11/26/2022]
Abstract
Opsoclonous myoclonous ataxia syndrome (OMAS) is a rare primarily immune-mediated disease in children. The current study aim was to find out the patterns and outcome of OMAS associated with neuroblastoma (NBL) among Children's Cancer Hospital-Egypt patients. Data was reviewed for 15 eligible patients enrolled between 2007 and 2016. OMAS treatment included prednisolone and cyclophosphamide with/without intravenous immunoglobulin; NBL treatment was given according to risk-corresponding protocol. Patients' age ranged from 0.75 to 12 years at presentation with male/female: 1.1/1. Concurrent diagnosis of OMAS and NBL occurred in 6 patients (40%). OMAS preceded NBL within 0.25 to 2 years in 33%, while NBL preceded OMAS within 0.5 to 1.5 years in 27%. Full OMAS picture was present in 10/15 patients, while 20% presented with truncal ataxia and myoclonus, 1 with truncal ataxia and opsoclonus, and 1 had opsoclonus and myoclonus. Median time till improvement of manifestations was 5 months. The 5-year OMAS progression-free survival was 33.3%, where 10 patients needed second-line therapy due to relapse/progression of OMAS. The median time to progression was 28 months measured from OMAS diagnosis. All patients remained alive with NBL 5-year overall survival of 100% and event-free survival of 85.7% for. However, 73% of the patients showed late sequelae ranging from ocular to cognitive, behavioral and motor disorders; rarely seizures and hemolytic anemia.
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Affiliation(s)
- Hossam Elzomor
- Departments of Pediatric Oncology
- National Cancer Institute
| | | | - Heba Elawady
- Neurology
- Pediatrics Department, Fayoum University, Fayoum, Egypt
| | | | | | | | - Hany Ghareeb
- Clinical Pharmacy, Children's Cancer Hospital Egypt
| | - Mohamed Fawzy
- Departments of Pediatric Oncology
- National Cancer Institute
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14
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Nutma S, Ruijter BJ, Beishuizen A, Tromp SC, Scholten E, Horn J, van den Bergh WM, van Kranen-Mastenbroek VH, Thomeer EC, Moudrous W, Aries M, van Putten MJ, Hofmeijer J. Myoclonus in comatose patients with electrographic status epilepticus after cardiac arrest: Corresponding EEG patterns, effects of treatment and outcomes. Resuscitation 2023; 186:109745. [PMID: 36822459 DOI: 10.1016/j.resuscitation.2023.109745] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/10/2023] [Accepted: 02/14/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVE To clarify the significance of any form of myoclonus in comatose patients after cardiac arrest with rhythmic and periodic EEG patterns (RPPs) by analyzing associations between myoclonus and EEG pattern, response to anti-seizure medication and neurological outcome. DESIGN Post hoc analysis of the prospective randomized Treatment of ELectroencephalographic STatus Epilepticus After Cardiopulmonary Resuscitation (TELSTAR) trial. SETTING Eleven ICUs in the Netherlands and Belgium. PATIENTS One hundred and fifty-seven adult comatose post-cardiac arrest patients with RPPs on continuous EEG monitoring. INTERVENTIONS Anti-seizure medication vs no anti-seizure medication in addition to standard care. MEASUREMENTS AND MAIN RESULTS Of 157 patients, 98 (63%) had myoclonus at inclusion. Myoclonus was not associated with one specific RPP type. However, myoclonus was associated with a smaller probability of a continuous EEG background pattern (48% in patients with vs 75% without myoclonus, odds ratio (OR) 0.31; 95% confidence interval (CI) 0.16-0.64) and earlier onset of RPPs (24% vs 9% within 24 hours after cardiac arrest, OR 3.86;95% CI 1.64-9.11). Myoclonus was associated with poor outcome at three months, but not invariably so (poor neurological outcome in 96% vs 82%, p = 0.004). Anti-seizure medication did not improve outcome, regardless of myoclonus presence (6% good outcome in the intervention group vs 2% in the control group, OR 0.33; 95% CI 0.03-3.32). CONCLUSIONS Myoclonus in comatose patients after cardiac arrest with RPPs is associated with poor outcome and discontinuous or suppressed EEG. However, presence of myoclonus does not interact with the effects of anti-seizure medication and cannot predict a poor outcome without false positives.
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Affiliation(s)
- Sjoukje Nutma
- Departments of Neurology and Clinical Neurophysiology, Medical Spectrum Twente, Enschede, the Netherlands; Department of Clinical Neurophysiology, Technical Medical Center, University of Twente, Enschede, the Netherlands.
| | - Barry J Ruijter
- Department of Clinical Neurophysiology, Technical Medical Center, University of Twente, Enschede, the Netherlands
| | - Albertus Beishuizen
- Departments of Neurology and Clinical Neurophysiology, Medical Spectrum Twente, Enschede, the Netherlands
| | - Selma C Tromp
- Departments of Neurology and Clinical Neurophysiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Erik Scholten
- Department of Critical Care, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Janneke Horn
- Department of Critical Care, Amsterdam University Medical Center, Location AMC, Amsterdam, the Netherlands
| | - Walter M van den Bergh
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Elsbeth C Thomeer
- Department of Neurology and Clinical Neurophysiology, Maasstad Hospital, Rotterdam, the Netherlands
| | - Walid Moudrous
- Department of Neurology and Clinical Neurophysiology, Maasstad Hospital, Rotterdam, the Netherlands
| | - Marcel Aries
- Department of Critical Care, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Michel Jam van Putten
- Departments of Neurology and Clinical Neurophysiology, Medical Spectrum Twente, Enschede, the Netherlands; Department of Clinical Neurophysiology, Technical Medical Center, University of Twente, Enschede, the Netherlands
| | - Jeannette Hofmeijer
- Department of Clinical Neurophysiology, Technical Medical Center, University of Twente, Enschede, the Netherlands; Department of Neurology, Rijnstate Hospital, Arnhem, the Netherlands
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15
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Baker AK, Griffith JL. To Treat or Not to Treat: Ethics of Management of Refractory Status Myoclonus Following Pediatric Anoxic Brain Injury. Semin Pediatr Neurol 2023; 45:101033. [PMID: 37003631 DOI: 10.1016/j.spen.2023.101033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 02/01/2023] [Accepted: 02/08/2023] [Indexed: 02/16/2023]
Abstract
The development of status myoclonus (SM) in a postcardiac arrest patient has historically been thought of as indicative of not only a poor neurologic outcome but of neurologic devastation. In many instances, this may lead clinicians to initiate conversations about withdrawal of life sustaining therapies (WLST) regardless of the time from return of spontaneous circulation (ROSC). Recent studies showing a percentage of patients may make a good recovery has called into question whether a self-fulfilling prophecy has developed where the concern for a poor neurologic outcome leads clinicians to prematurely discuss WLST. The issue is only further complicated by changing terminology, lack of neuro-axis localization, and limited data regarding association with electroencephalogram (EEG) characteristics, all of which could aid in the understanding of the severity of neurologic injury associated with SM. Here we review the initial literature reporting SM as indicative of poor neurologic outcome, the studies that call this into question, the various definitions of SM and related terms as well as data regarding association with EEG backgrounds. We propose that improved prognostication on outcomes results from combining the presence of SM with other clinical variables (eg EEG patterns, MRI findings, and clinical exam). We discuss the ethical implications of using SM as a prognostic tool and its impact on decisions about life-sustaining care in children following cardiac arrest. We advocate for prognostication efforts to be delayed for at least 72 hours following ROSC and thus to treat SM in those early hours and days.
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Affiliation(s)
- Alyson K Baker
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE; Children's Hospital and Medical Center, Omaha, NE.
| | - Jennifer L Griffith
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO; Department of Neurology, Washington University School of Medicine, St. Louis, MO
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16
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Reyes NGD, Di Luca DG, McNiven V, Lang AE. Dystonia with myoclonus and vertical supranuclear gaze palsy associated with a rare GNB1 variant. Parkinsonism Relat Disord 2023; 106:105239. [PMID: 36521323 DOI: 10.1016/j.parkreldis.2022.105239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/29/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
GNB1 encephalopathy (OMIM: 616973), caused by pathogenic variants in the GNB1 gene, is a rare neurodevelopmental syndrome characterized by global developmental delay (GDD) variably co-occurring with movement disorders. For the latter, dystonia, although the most frequent, remains uncommon. Other phenomenologies including myoclonus, tics, chorea, and ataxia, as well as oculomotor abnormalities are rare [1]. Most pathogenic variants in GNBI occur in exons 6 and 7, which are considered to be mutational hotspots [2]. Here, we report a case of GNB1 encephalopathy arising from a de novo mutation in a gene region with few reported pathogenic variants (i.e., exon 11) presenting with a unique phenotype consisting of dystonia with myoclonus and vertical supranuclear gaze palsy.
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Affiliation(s)
- Nikolai Gil D Reyes
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada.
| | - Daniel G Di Luca
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Vanda McNiven
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada; Fred A Litwin Family Centre in Genetic Medicine, University Health Network and Mount Sinai Hospital, Toronto, ON, M5T 3L9, Canada.
| | - Anthony E Lang
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada.
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17
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Osawa K, Sugiyama A, Uzawa A, Hirano S, Yamamoto T, Nezu M, Araki N, Kano H, Kuwabara S. Temporal Changes in Brain Perfusion in a Patient with Myoclonus and Ataxia Syndrome Associated with COVID-19. Intern Med 2022; 61:1071-1076. [PMID: 35110499 PMCID: PMC9038453 DOI: 10.2169/internalmedicine.9171-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Myoclonus and ataxia, with or without opsoclonus, have recently been recognized as a central nervous system syndrome associated with coronavirus disease-2019 (COVID-19). A 52-year-old Japanese man developed myoclonus and ataxia 16 days after the onset of COVID-19. Brain single-photon emission computed tomography (SPECT) revealed hyperperfusion in the cerebellum and hypoperfusion in the cerebral cortices with frontal predominance during the acute stage, which improved over two months. This study indicates that brain perfusion SPECT can be effective in detecting functional alterations in COVID-19-related myoclonus and ataxia.
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Affiliation(s)
- Kenta Osawa
- Department of Neurology, Graduate School of Medicine, Chiba University, Japan
| | - Atsuhiko Sugiyama
- Department of Neurology, Graduate School of Medicine, Chiba University, Japan
| | - Akiyuki Uzawa
- Department of Neurology, Graduate School of Medicine, Chiba University, Japan
| | - Shigeki Hirano
- Department of Neurology, Graduate School of Medicine, Chiba University, Japan
| | - Tatsuya Yamamoto
- Department of Neurology, Graduate School of Medicine, Chiba University, Japan
- Department of Rehabilitation, Division of Occupational Therapy, Chiba Prefectural University of Health Sciences, Japan
| | - Masahiko Nezu
- Department of Kampo Medicine, Chiba University Hospital, Japan
| | - Nobuyuki Araki
- Department of Neurology, Graduate School of Medicine, Chiba University, Japan
| | - Hiroki Kano
- Department of Neurology, Graduate School of Medicine, Chiba University, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Japan
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18
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Álvarez Bravo G, Sánchez Cirera L, Angerri Nadal M, Ramió i Torrentà L. Clinical heterogeneity in patients with myoclonus associated to COVID-19. Neurol Sci 2022; 43:1587-1592. [PMID: 34988717 PMCID: PMC8731181 DOI: 10.1007/s10072-021-05802-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/02/2021] [Indexed: 11/30/2022]
Abstract
Objective This study aims to report the clinical heterogeneity of myoclonus in 6 patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods Patient data were obtained from medical records from the University Hospital Dr. Josep Trueta, Girona, Spain. Results Six patients (5 men and 1 woman, aged 60–76 years) presented with different myoclonus phenotypes. All of them had a medical history of hypertension and overweight. The latency of myoclonus appearance ranged from 1 to 129 days. The phenotype most observed was generalized myoclonus. Special phenotypes such as painful legs and moving toes syndrome with jerking feet, Lazarus sign-like, action myoclonus/ataxia syndrome, and segmental myoclonus secondary to myelitis have been described too. Levetiracetam and clonazepam were medications most used successfully. Two patients died for complications not related to myoclonus. Conclusions Our 6 cases highlight the heterogeneity of the clinical spectrum of myoclonus associated to COVID-19 (MYaCO). MYaCO pathogenesis is suspected to be due to an immune-mediated para- or post-infectious phenomenon; nevertheless, further research is needed to elucidate this hypothesis. Supplementary Information The online version contains supplementary material available at 10.1007/s10072-021-05802-1.
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Affiliation(s)
- Gary Álvarez Bravo
- Department of Neurology, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
- Unit of Neuroimmunology and Multiple Sclerosis, Department of Neurology, University Hospital Josep Trueta of Girona, Girona, Spain
| | - Laura Sánchez Cirera
- Department of Neurology, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - Mònica Angerri Nadal
- Department of Internal Medicine, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - Lluís Ramió i Torrentà
- Department of Neurology, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
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Fiani B, Runnels J, Sarhadi K, Sarno E, Kondilis A. Oncologic causes of oculopalatal tremors: neurophysiology and treatment. Acta Neurol Belg 2021; 121:1111-1116. [PMID: 34286476 DOI: 10.1007/s13760-021-01761-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 07/16/2021] [Indexed: 11/29/2022]
Abstract
Oculopalatal tremor (OPT) is an acquired pathology characterized by continuous and rhythmical soft palatal movements combined with pendular nystagmus. Aside from vascular lesions, oncological masses affecting the dentatorubro-olivary pathway can impair brainstem and/or cerebellar pathways, manifesting as dyssynchronous movement. In this review, we delve into the neurophysiology of OPT along with oncological causes and treatment options based on the most recent clinical trial data. This literature review includes medication treatment data from clinical trials enrolling individuals with features of OPT, including acquired pendular nystagmus (APN). Trials were deemed eligible for inclusion in this review if one or more participants had symptoms determined by the trial authors to be caused by OPT. Trials investigating the treatment of APN secondary to a separate cause, such as multiple sclerosis, were excluded from this review. Several early treatments failed to demonstrate a benefit for patients with APN due to OPT. Trials of anticholinergic agents were largely ineffective and poorly tolerated. Botulinum toxin A demonstrated improvement in APN symptoms. Most recently, trials including memantine and gabapentin have demonstrated success with attenuation of APN. Surgical modalities such as DBS have yet to show improvement, though with only a single case report as evidence. Oculopalatal tremor is a unique manifestation of posterior fossa tumors disrupting the Guillain-Mollaret triangle. Symptom control through medication management has had limited success attributed to poor response and medication intolerance. Surgical modalities like DBS may have an emerging role in OPT treatment by targeting dyssynchronous activity in the dentatorubro-olivary pathway.
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Affiliation(s)
- Brian Fiani
- Department of Neurosurgery, Desert Regional Medical Center, 1150 N. Indian Canyon Dr., Palm Springs, CA, 92262, USA.
| | - Juliana Runnels
- Department of Radiation Oncology, Mount Sinai Hospital, New York, NY, USA
| | - Kasra Sarhadi
- Department of Neurology, University of Washington, Seattle, WA, USA
| | - Erika Sarno
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Athanasios Kondilis
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
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20
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Kitazaki Y, Ikawa M, Kishitani T, Kamisawa T, Nakane S, Nakamoto Y, Hamano T. Progressive Encephalomyelitis with Rigidity and Myoclonus (PERM)-like Symptoms Associated with Anti-ganglionic Acetylcholine Receptor Antibodies. Intern Med 2021; 60:2307-2313. [PMID: 33583893 PMCID: PMC8355408 DOI: 10.2169/internalmedicine.6419-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This report describes a 59-year-old woman who presented with progressive encephalomyelitis with rigidity and myoclonus (PERM)-like symptoms and severe dysautonomia, including orthostatic hypotension, sinus bradycardia, dysuria, and prolonged constipation. Her neurological symptoms improved after immunotherapy, but the dysautonomia persisted. Anti-ganglionic acetylcholine receptor (gAChR) α3 subunit antibodies, which are frequently identified in patients with autoimmune autonomic ganglionopathy, were detected in the pre-treatment serum. The central distribution of the nicotinic acetylcholine receptors, a target of anti-gAChR antibodies, and immunotherapeutic efficacy observed in this case indicate that anti-gAChR α3 subunit antibodies are associated with the PERM-like features accompanied by autonomic manifestations.
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Affiliation(s)
- Yuki Kitazaki
- Department of Neurology, Fukui-ken Saiseikai Hospital, Japan
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Japan
| | - Masamichi Ikawa
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Japan
- Department of Advanced Medicine for Community Healthcare, Faculty of Medical Sciences, University of Fukui, Japan
| | - Toru Kishitani
- Department of Neurology, Fukui-ken Saiseikai Hospital, Japan
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Japan
| | - Tomoko Kamisawa
- Department of Neurology, Fukui-ken Saiseikai Hospital, Japan
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Japan
| | - Shunya Nakane
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Japan
| | - Yasunari Nakamoto
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Japan
| | - Tadanori Hamano
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Japan
- Department of Aging and Dementia, Faculty of Medical Sciences, University of Fukui, Japan
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21
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Shikino K, Sato R, Hanazawa N, Yasuda M, Ikusaka M. Chronic clicking tinnitus due to palatal tremor: essential or secondary? Lancet 2021; 397:e16. [PMID: 34147152 DOI: 10.1016/s0140-6736(21)01247-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 03/26/2021] [Accepted: 05/18/2021] [Indexed: 11/23/2022]
Affiliation(s)
- Kiyoshi Shikino
- Department of General Medicine, Chiba University Hospital, Japan.
| | - Rurika Sato
- Department of General Medicine, Chiba University Hospital, Japan
| | - Nao Hanazawa
- Department of General Medicine, Chiba University Hospital, Japan
| | - Manato Yasuda
- Department of Neurology, Graduate School of Medicine, Chiba University, Japan
| | - Masatomi Ikusaka
- Department of General Medicine, Chiba University Hospital, Japan
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22
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Uçan Tokuç FE, Genç F, Erdal A, Biçer Gömceli Y. Report of two siblings with action myoclonus renal failure syndrome. Seizure 2021; 88:73-74. [PMID: 33836450 DOI: 10.1016/j.seizure.2021.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/14/2021] [Accepted: 03/19/2021] [Indexed: 10/21/2022] Open
Affiliation(s)
- F E Uçan Tokuç
- Department of Neurology, Antalya Training and Research Hospital, Antalya, Turkey.
| | - F Genç
- Department of Neurology, Antalya Training and Research Hospital, Antalya, Turkey
| | - A Erdal
- Department of Neurology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Y Biçer Gömceli
- Department of Neurology, Antalya Training and Research Hospital, Antalya, Turkey
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23
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Salehi PP, Kasle D, Torabi SJ, Michaelides E, Hildrew DM. The etiology, pathogeneses, and treatment of objective tinnitus: Unique case series and literature review. Am J Otolaryngol 2019; 40:594-597. [PMID: 30981445 DOI: 10.1016/j.amjoto.2019.03.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 03/25/2019] [Indexed: 11/30/2022]
Abstract
We present two unique cases of myoclonus-induced objective tinnitus (OT), along with a comprehensive literature review on the topic. Primary goals include: explore the relationship between palatal myoclonus (PM) and middle ear myoclonus (MEM), highlight the embryologic, neurologic, and anatomical relationship between the involved peri-tubular muscles, exemplify the first case of OT which documents video evidence demonstrating the link between objective tinnitus and eustachian tube movement. Also, we discuss available treatment interventions and why they often do not fully resolve patients' symptoms. Finally we introduce a novel way to objectively quantify the severity of OT. Ultimately, our series hopes to inform future diagnostic and treatment guidelines.
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Affiliation(s)
- Parsa P Salehi
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Yale University School of Medicine, New Haven, CT, United States of America
| | - David Kasle
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Yale University School of Medicine, New Haven, CT, United States of America
| | - Sina J Torabi
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Yale University School of Medicine, New Haven, CT, United States of America
| | - Elias Michaelides
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Yale University School of Medicine, New Haven, CT, United States of America
| | - Douglas M Hildrew
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Yale University School of Medicine, New Haven, CT, United States of America.
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24
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Hornibrook J, Keast A. Bilateral clicking tinnitus due to myoclonus of middle ear muscles. N Z Med J 2019; 132:67-69. [PMID: 30921313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Isolated middle ear myoclonus can be a cause of objective tinnitus. We present an acoustically documented case of irregular bilateral middle ear myoclonus with loud clicking, and roaring tinnitus associated with essential palatal tremor. A palatal botulinum toxin injection did not eliminate the tinnitus. Division of both middle ear tendons in both ears abolished the clicking tinnitus with no effect on hearing.
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Affiliation(s)
- Jeremy Hornibrook
- Otolaryngologist Department of Otolaryngology, Head and Neck Surgery, Christchurch Hospital, Christchurch
| | - Allan Keast
- Otolaryngologist Department of Otolaryngology, Head and Neck Surgery, Christchurch Hospital, Christchurch
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25
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Ozaki K, Ohkubo T, Yamada T, Yoshioka K, Ichijo M, Majima T, Kudo S, Akashi T, Honda K, Ito E, Watanabe M, Sekine M, Hamagaki M, Eishi Y, Sanjo N, Ishibashi S, Mizusawa H, Yokota T. Progressive Encephalomyelitis with Rigidity and Myoclonus Resolving after Thymectomy with Subsequent Anasarca: An Autopsy Case. Intern Med 2018; 57:3451-3458. [PMID: 29984771 PMCID: PMC6306531 DOI: 10.2169/internalmedicine.1238-18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Progressive encephalomyelitis with rigidity and myoclonus (PERM) is an autoimmune disorder involving the brainstem and spinal cord and is sometimes associated with thymoma. We encountered a 75-year-old woman with typical PERM features, glycine receptor antibody, and thymoma. Her neurologic symptoms improved after thymectomy, but she unexpectedly developed anasarca with massive pleural effusions and hypoalbuminemia and finally succumbed to death. The autopsy showed edema and mononuclear infiltration in the pleura but no neuropathological findings typical of PERM. Effective treatment of PERM can reverse the neuropathological signs of encephalomyelitis. The autoimmune nature of anasarca is possible but not proven.
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Affiliation(s)
- Kokoro Ozaki
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Takuya Ohkubo
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Tetsuo Yamada
- Department of Clinical Laboratory Medicine, Graduate School of Health Care Science, Bunkyo Gakuin University, Japan
| | - Kotaro Yoshioka
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Masahiko Ichijo
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Takamasa Majima
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Shunsuke Kudo
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Takumi Akashi
- Department of Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Keiji Honda
- Department of Otolaryngology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Eisaku Ito
- Department of Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Mayumi Watanabe
- Department of Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Masaki Sekine
- Department of Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Miwako Hamagaki
- Department of Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Yoshinobu Eishi
- Department of Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Nobuo Sanjo
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Satoru Ishibashi
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Hidehiro Mizusawa
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
- The National Center Hospital, National Center of Neurology and Psychiatry, Japan
| | - Takanori Yokota
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
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26
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Shifan SS, Schousboe LP, Marker F. [Objective tinnitus]. Ugeskr Laeger 2018; 180:V01180084. [PMID: 30259831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Objective tinnitus is a known but rare otologic symptom. This is a case report about a six-year-old boy, who was referred to a hearing clinic for further investigation of an audible clicking sound. He experienced clicking sounds, and his parents were able to hear the sounds when listening nearby. This objective tinnitus is caused by myoclonus of either the m. tensor tympani or the m. stapedius. We discuss methods to evaluate objective tinnitus including the clinical use of a stethoscope and also the possibility of using impedance measuring in patients with objective tinnitus.
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27
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Affiliation(s)
- Adrian R Brown
- University Department of Psychiatry, Longley Centre, Norwood Grange Drive, Sheffield S5 7JT, UK.
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28
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Abstract
A woman aged 22 years presented with a 3-year history of jerks when brushing her teeth and a tremor when carrying drinks. Examination revealed a bilateral jerky tremor, stimulus-sensitive myoclonus, and difficulty with tandem gait. Thyroid and liver function test results were normal, but she had rapidly progressive renal failure. Serum copper, ceruloplasmin, and manganese levels were normal, but her urinary copper level was elevated on 2 occasions. Pathological findings on organ biopsy prompted genetic testing to confirm the diagnosis. The differential diagnosis, tissue biopsy findings, and final genetic diagnosis are discussed.
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Affiliation(s)
- Karen M Doherty
- Regional Neurosciences Unit, Royal Victoria Hospital, Belfast, Northern Ireland
| | - Joanne Shields
- Regional Nephrology Unit, Belfast City Hospital, Belfast, Northern Ireland
| | - Raeburn Forbes
- Department of Neurology, Craigavon Area Hospital, Portadown, Northern Ireland
| | - Moyra Gray
- Department of Pathology, Royal Victoria Hospital, Belfast, Northern Ireland
| | - Seamus Kearney
- Regional Neurosciences Unit, Royal Victoria Hospital, Belfast, Northern Ireland
| | | | - John McKinley
- Regional Neurosciences Unit, Royal Victoria Hospital, Belfast, Northern Ireland
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29
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Coppola A, Caccavale C, Santulli L, Balestrini S, Cagnetti C, Licchetta L, Esposito M, Bisulli F, Tinuper P, Provinciali L, Minetti C, Zara F, Striano P, Striano S. Psychiatric comorbidities in patients from seven families with autosomal dominant cortical tremor, myoclonus, and epilepsy. Epilepsy Behav 2016; 56:38-43. [PMID: 26827300 DOI: 10.1016/j.yebeh.2015.12.038] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 12/20/2015] [Accepted: 12/23/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The objective of this report was to assess the psychiatric comorbidity in a group of patients affected by autosomal dominant cortical tremor, myoclonus, and epilepsy (ADCME). METHODS Reliable and validated psychodiagnostic scales including the BDI (Beck Depression Inventory), STAI-Y1 and 2 (State-Trait Anxiety Inventory - Y; 1 and 2), MMPI-2 (Minnesota Multiphasic Personality Inventory - 2), and QoLIE-31 (Quality of Life in Epilepsy Inventory - 31) were administered to 20 patients with ADCME, 20 patients with juvenile myoclonic epilepsy (JME), and 20 healthy controls. RESULTS There was a higher prevalence of mood disorders in patients with ADCME compared to patients with JME and healthy controls, particularly depression (p=0.035 and p=0.017, respectively) and state anxiety (p=0.024 and p=0.019, respectively). Trait anxiety was not different from JME (p=0.102) but higher than healthy controls (p=0.017). The myoclonus score positively correlated with both state (rho: 0.58, p=0.042) and trait anxiety (rho: 0.65, p=0.011). These psychiatric features were also often associated with pathological traits of personality: paranoid (OR: 25.7, p=0.003), psychasthenia (OR: 7.0, p=0.023), schizophrenia (OR: 8.5, p=0.011), and hypomania (OR: 5.5, p=0.022). Finally, in patients with ADCME, decreased quality of life correlated with these psychiatric symptoms. SIGNIFICANCE Patients with ADCME show a significant psychiatric burden that impairs their quality of life. A comprehensive psychiatric evaluation should be offered at the time of diagnosis to detect these comorbidities and to treat them.
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Affiliation(s)
- Antonietta Coppola
- Epilepsy Centre, Department of Neuroscience, Odontostomatology and Reproductive Sciences, Federico II University, Naples, Italy; Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, "G. Gaslini" Institute, Genova, Italy.
| | - Carmela Caccavale
- Epilepsy Centre, Department of Neuroscience, Odontostomatology and Reproductive Sciences, Federico II University, Naples, Italy
| | - Lia Santulli
- Epilepsy Centre, Department of Neuroscience, Odontostomatology and Reproductive Sciences, Federico II University, Naples, Italy
| | - Simona Balestrini
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, UK; Epilepsy Society, Chesham Lane, Chalfont St. Peter, Bucks, UK; Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Claudia Cagnetti
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Laura Licchetta
- IRCCS, Neurological Science Institute of Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Marcello Esposito
- Department of Neurological Science, Odontostomatology and Reproductive Sciences, Federico II University, Naples, Italy
| | - Francesca Bisulli
- IRCCS, Neurological Science Institute of Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Paolo Tinuper
- IRCCS, Neurological Science Institute of Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Leandro Provinciali
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Carlo Minetti
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, "G. Gaslini" Institute, Genova, Italy
| | - Federico Zara
- Laboratory of Neurogenetics and Neurosciences, Department of Neurosciences, "G. Gaslini" Institute, Genova, Italy
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, "G. Gaslini" Institute, Genova, Italy
| | - Salvatore Striano
- Epilepsy Centre, Department of Neuroscience, Odontostomatology and Reproductive Sciences, Federico II University, Naples, Italy
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30
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Gupta HV, Ramakrishnaiah RH, Sharp GB, Lee RW, Walters WD. A combination of chorea, myoclonus, and dystonia in a patient with pontocerebellar hypoplasia type 2: a video case presentation. Acta Neurol Belg 2015; 115:783-5. [PMID: 25837317 DOI: 10.1007/s13760-015-0461-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/17/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Harsh V Gupta
- Department of Neurology, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Slot # 500, Little Rock, AR, 72205, USA.
| | - Raghu H Ramakrishnaiah
- Department of Radiology, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Slot # 500, Little Rock, AR, 72205, USA.
| | - Gregory B Sharp
- Department of Neurology, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Slot # 500, Little Rock, AR, 72205, USA.
| | - Ricky W Lee
- Department of Neurology, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Slot # 500, Little Rock, AR, 72205, USA.
| | - William D Walters
- Department of Neurology, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Slot # 500, Little Rock, AR, 72205, USA.
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31
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Abstract
Background:Subacute sclerosing panencephalitis (SSPE) is a rare complication of measles virus infection. The disease is characterized by behavioural abnormalities, intellectual deterioration, motor weakness, and generalized myoclonic jerks progressing to coma and death in one to two years in 80% of the cases. The myoclonic jerks are associated with characteristic generalized slow periodic complexes on electroencephalography (EEG). The symptoms and signs of SSPE are frequently quite variable. The clinical course is equally variable and difficult to predict. The characteristic periodic myoclonus can rarely occur unilaterally particularly in the early stages of the disease. As well, the periodic EEG complexes have been reported unilaterally in up to 3% of cases.Case Report:A 12-year-old boy, who was seen at a later stage with atypical manifestation of myoclonic body jerks confined entirely unilaterally, combined with contralateral periodic EEG complexes. One could assume clinically that the more diseased hemisphere was responsible for generating the jerks. However, brain magnetic resonance imaging revealed asymmetric hemispheric changes suggesting that the less neurologically damaged hemisphere is responsible for generating the unilateral myoclonic jerks. This has led to the interpretation that the more severely damaged hemisphere has lost the neuronal connectivity required to generate these periodic myoclonic jerks.Conclusion:Subacute sclerosing panencephalitis may have asymmetric hemispheric involvement, not only early, but also in the advanced stages of the disease, which can result in unilateral periodic myoclonic jerks.
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Affiliation(s)
- Zaitoon M Shivji
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Jeddah, Kingdom of Saudi Arabia
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32
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Abstract
Dysphagia is a common problem in the elderly patient. Palato-pharyngo-laryngeal myoclonus, however, is a rare cause of this. We report a case of a 78-year-old man with dysphagia due to palato-pharngo-laryngeal myoclonus that was ultimately managed conservatively with a good functional outcome.
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Affiliation(s)
- Angela G Juby
- Geriatrics, University of Alberta, 1-108 Clinical Sciences Building 11350 83 Avenue, Edmonton, Alberta, Canada T6G 2P4
| | - Patti Shandro
- Geriatrics, Alberta Health Services, Edmonton, Alberta, Canada
| | - Derek Emery
- Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
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33
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Affiliation(s)
- Deepak Sharma
- Department of Neonatology, Fernandez Hospital, Hyderabad, Andhra Pradesh, India
| | - Srinivas Murki
- Department of Neonatology, Fernandez Hospital, Hyderabad, Andhra Pradesh, India
| | - Oleti Tejo Pratap
- Department of Neonatology, Fernandez Hospital, Hyderabad, Andhra Pradesh, India
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Shibata T, Yoshinaga H, Oka M, Kobayashi K. [West syndrome associated with epileptic negative myoclonus]. No To Hattatsu 2014; 46:354-358. [PMID: 25403066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We report a 10-month-old girl who had brief epileptic negative myoclonus during the course of West syndrome. She began to have epileptic spasms in series at the age of 8 months. Video-electroencephalograph (EEG) monitoring revealed that she also had brief epileptic negative myoclonus when she was 10 months old. Brief atonia of limbs occurred in isolation or in a cluster during drowsiness or sleep. The ictal EEG exhibited diffuse polyspikes and waves or diffuse high-voltage slow waves that were overlapped by low-voltage fast waves. 3 to 4 hundred milliseconds of silent periods were observed in the bilateral deltoid electromyograms, which correspond to the EEG patterns. The occurrence of other types of seizures, partial seizures in particular, accompanied by epileptic spasms has been fully investigated. This is the first case report of a patient with West syndrome whose coexisting epileptic negative myoclonus was confirmed by a silent electromyogram pattern.
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Torio M, Sanefuji M, Hara T. [A one-year-old male infant with sleep-associated febrile myoclonus]. No To Hattatsu 2013; 45:314-317. [PMID: 23951945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Febrile myoclonus is a benign neurological symptom induced by fever. The physiological mechanism is unknown. We herein report a 1 year and 7 months old male patient with intermittent jerks of the whole body during a high fever caused by acute otitis media. He experienced more than 50 jerks over a period of 2 days. The jerks appeared only during sleep. He showed no impairment of consciousness and no abnormalities in neurological examination, blood examination, electroencephalogram, or brain MRI findings. We diagnosed him with febrile myoclonus. The myoclonic jerks disappeared as the fever decreased without neurological sequelae. To the best of our knowledge, febrile myoclonus only during sleep has never been reported. To clarify the pathophysiology of febrile myoclonus, we should focus on the relationship between the myoclonus and the sleep/awake states.
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Affiliation(s)
- Michiko Torio
- Department of Pediatrics, Fukuoka Red Cross Hospital, Fukuoka.
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Tai KK, Truong DD. Amiloride but not memantine reduces neurodegeneration, seizures and myoclonic jerks in rats with cardiac arrest-induced global cerebral hypoxia and reperfusion. PLoS One 2013; 8:e60309. [PMID: 23593189 PMCID: PMC3620224 DOI: 10.1371/journal.pone.0060309] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 02/26/2013] [Indexed: 01/02/2023] Open
Abstract
It has been reported that both activation of N-methyl-D-aspartate receptors and acid-sensing ion channels during cerebral ischemic insult contributed to brain injury. But which of these two molecular targets plays a more pivotal role in hypoxia-induced brain injury during ischemia is not known. In this study, the neuroprotective effects of an acid-sensing cation channel blocker and an N-methyl-D-aspartate receptor blocker were evaluated in a rat model of cardiac arrest-induced cerebral hypoxia. We found that intracisternal injection of amiloride, an acid-sensing ion channel blocker, dose-dependently reduced cerebral hypoxia-induced neurodegeneration, seizures, and audiogenic myoclonic jerks. In contrast, intracisternal injection of memantine, a selective uncompetitive N-methyl-D-aspartate receptor blocker, had no significant effect on cerebral hypoxia-induced neurodegeneration, seizure and audiogenic myoclonic jerks. Intracisternal injection of zoniporide, a specific sodium-hydrogen exchanger inhibitor, before cardiac arrest-induced cerebral hypoxia, also did not reduce cerebral hypoxia-induced neurodegeneration, seizures and myoclonic jerks. These results suggest that acid-sensing ion channels play a more pivotal role than N-methyl-D-aspartate receptors in mediating cerebral hypoxia-induced brain injury during ischemic insult.
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Affiliation(s)
- Kwok Keung Tai
- The Parkinson's and Movement Disorder Research Laboratory, Long Beach Memorial Medical Center, Long Beach, California, United States of America.
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Abstract
Epileptic myoclonus can be defined as an elementary electroclinical manifestation of epilepsy involving descending neurons, whose spatial (spread) or temporal (self-sustained repetition) amplification can trigger overt epileptic activity and can be classified as cortical (positive and negative), secondarily generalized, thalamo-cortical, and reticular. Cortical epileptic myoclonus represents a fragment of partial or symptomatic generalized epilepsy; thalamo-cortical epileptic myoclonus is a fragment of idiopathic generalized epilepsy. Reflex reticular myoclonus represents the clinical counterpart of fragments of hypersynchronous epileptic activity of neurons in the brainstem reticular formation. Epileptic myoclonus, in the setting of an epilepsy syndrome, can be only one component of a seizure, the only seizure manifestations, one of the multiple seizure types or a more stable condition that is manifested in a nonparoxysmal fashion and mimics a movement disorder. This complex correlation is more obvious in patients with epilepsia partialis continua in which cortical myoclonus and overt focal motor seizures usually start in the same somatic (and cortical) region. In patients with cortical tremor this correlation is less obvious and requires neurophysiological studies to be demonstrated.
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Affiliation(s)
- Renzo Guerrini
- Pediatric Neurology Unit and Laboratories, Children's Hospital A. Meyer - University of Florence, Florence, Italy.
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Wan TK, Chen JT, Wang PC. EMG-guided salpingopharyngeus Botox injection for palatal myoclonus. B-ENT 2013; 9:67-69. [PMID: 23641594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
Palatal myoclonus (PM) is a rare neurological disorder characterized by involuntary movements of the soft palate musculature causing objective clicking tinnitus. Two forms are recognized as distinct clinical entities, with poorly understood pathogenesis: essential and symptomatic PM. The intrusive nature of the tinnitus prompts patients to seek medical advice. Conventional medical treatments with anxiolytics, antidepressants, and anticonvulsants have limited efficacy in these patients. In this case report, electromyography-guided injection of botulinum toxin type A (Botox; Allergan, Irvine, CA, USA) to the involved salpingopharyngeus and tensor veli palatini yielded satisfactory results with minimal temporary adverse effects.
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Affiliation(s)
- T K Wan
- Department of Otolaryngology, Head and Neck Surgery, Cathay General Hospital, Taipei, Taiwan
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Armstrong MJ, Shah BB, Chen R, Angel MJ, Lang AE. Expanding the phenomenology of benign hereditary chorea: evolution from chorea to myoclonus and dystonia. Mov Disord 2011; 26:2296-7. [PMID: 21714005 DOI: 10.1002/mds.23822] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Revised: 04/01/2011] [Accepted: 05/12/2011] [Indexed: 11/08/2022] Open
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Abstract
Spinal segmental myoclonus is defined as a rare involuntary movement characterized by myoclonic jerks of spinal origin. We describe the case of a 62-year-old woman who developed spinal segmental myoclonus 4 months after undergoing cervical laminoplasty for ossification of the posterior longitudinal ligament. Myoclonic jerks were observed in the upper trapezius innervated by C3-4, which corresponded to the level of myelomalacia. These jerks were elicited and aggravated in the sitting and standing positions but were completely suppressed in the supine position. The myoclonus was refractory to medication but improved with the use of a soft neck brace.
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Affiliation(s)
- Junpei Kobayashi
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Japan.
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Hitomi T, Ikeda A, Inouchi M, Imamura H, Nakagawa T, Fumuro T, Matsumoto R, Takahashi R. Transient myoclonic state with asterixis: primary motor cortex hyperexcitability is correlated with myoclonus. Intern Med 2011; 50:2303-9. [PMID: 22001455 DOI: 10.2169/internalmedicine.50.5590] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To clarify the clinical features and mechanism of the transience of myoclonus in patients with a transient myoclonic state with asterixis (TMA). METHODS We investigated the clinical and eletrophysiological profiles of 6 patients with TMA (age: 84±3 years). During an asymptomatic period, somatosensory evoked potentials (SEPs) were recorded in all 6 patients and motor evoked potentials (MEPs) were examined in 1 patient. SEPs were recorded and jerk-locked back averaging (JLA) was performed in 2 patients while symptomatic. SEPs were also recorded from 8 aged control subjects (age: 68±5 years). RESULTS All TMA patients had mild chronic systemic diseases. During an asymptomatic period, SEP amplitudes were not significantly enlarged in comparison with control subjects, and MEPs were normal. Examination of 2 patients during symptomatic period indicated no enlargement of SEP amplitudes and JLA disclosed a positive spike preceding myoclonic jerks. In one of these patients, the amplitude of the positive spike decreased once myoclonus improved. CONCLUSION TMA occurred in aged patients with mild chronic systemic diseases. JLA findings and the absence of giant SEPs further support that TMA is a cortical non-reflex myoclonus. In addition, transient hyperexcitability at the primary motor cortex disclosed by JLA correlated well with its transient symptoms.
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Wong SH, Steiger MJ, Larner AJ, Fletcher NA. Hereditary myoclonus dystonia (DYT11): a novel SGCE gene mutation with intrafamilial phenotypic heterogeneity. Mov Disord 2010; 25:956-7. [PMID: 20222131 DOI: 10.1002/mds.23037] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Poston KL, McGovern RA, Goldman JS, Caccappolo E, Mazzoni P. Fragile X-associated tremor/ataxia syndrome (FXTAS) with myoclonus. Mov Disord 2010; 25:514-6. [PMID: 20063436 DOI: 10.1002/mds.22929] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Hindle JV, Bridges L, Chohan G. Dementia with Lewy bodies associated with ataxia, myoclonus, and cortical blindness. Mov Disord 2010; 25:1301-2. [PMID: 20310054 DOI: 10.1002/mds.23074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Wojtecki L, Groiss S, Scherfeld D, Albrecht P, Pollok B, Elben S, Wille C, Vesper J, Schnitzler A. Transient improvement of psychogenic (proprio-)spinal-like myoclonus to electrical nerve stimulation. Mov Disord 2010; 24:2024-5. [PMID: 19645072 DOI: 10.1002/mds.22710] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Chan C, Palaniappan R. Middle ear myoclonus: a new technique for suppression of spontaneous clicking tinnitus. Int Tinnitus J 2010; 16:51-54. [PMID: 21609914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Middle ear myoclonus is one of the causes of clicking tinnitus and can be psychologically distressing. Current management of intractable clicking includes medication or tenotomy. Two cases with spontaneous intrusive irregular clicking are presented where relief and a sense of control were obtained using non-invasive self - administered zygomatic pressure. This technique may be useful in selected patients before resorting to medication or tenotomy.
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Affiliation(s)
- Chung Chan
- Audiological Medicine Department, Royal National Hospital for Throat, Nose and Ear, London, UK.
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Balcarek P, Dresing K, Walde TA, Tezval M, Stürmer KM. Myoclonus-induced bilateral acetabular fracture dislocations. J Arthroplasty 2009; 24:826.e11-5. [PMID: 18703309 DOI: 10.1016/j.arth.2008.05.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2007] [Revised: 03/03/2008] [Accepted: 05/05/2008] [Indexed: 02/01/2023] Open
Abstract
An uncommon case of myoclonus-induced bilateral central acetabular fracture-dislocation is presented. Although different fracture types due to forceful muscular contractions have been reported, this is an exceedingly uncommon injury pattern. Bilateral total hip arthroplasty, in combination with a reinforcement ring and autologous bone grafting, was performed after open reduction and internal fixation.
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Affiliation(s)
- Peter Balcarek
- Department of Trauma Surgery, Plastic and Reconstructive Surgery, University Medicine, Goettingen, Germany
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Abstract
PURPOSE To evaluate the development or worsening of myoclonus in patients receiving gabapentin (GBP). METHODS Clinical charts of 162 patients treated with GBP were reviewed concerning development or worsening of myoclonus. RESULTS We found 3 cases (1.9%) of myoclonus. Two patients had preexisting myoclonus and generalized tonic-clonic seizures, while the other one had generalized tonic-clonic seizures only. All patients experienced development or worsening of myoclonus within 2 weeks after starting GBP. Dose at the onset of development or worsening of myoclonus varied from 600 mg to 1,800 mg. Two patients developed multifocal myoclonus. Discontinuation of GBP or clonazepam add-on resulted in cessation of myoclonus with no serious sequela. CONCLUSION GBP may increase the risk of development of de novo myoclonus or worsening of myoclonus in patients with preexistent myoclonus. According to the result of this study and the treatment guidelines, GBP should be avoided when a patient has preexistent myoclonus.
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Affiliation(s)
- Yasumichi Koide
- National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders
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