Â鶹´«Ã½Ó³»­

Â鶹´«Ã½Ó³»­

Explore the latest content from across our publications
Join The Â鶹´«Ã½Ó³»­

Log In

Forgot Password?
Create New Account

Loading... please wait

Abstract Details

The Twitching Trunk: Etiology and Treatment of Truncal Myoclonus
Cerebrovascular Disease and Interventional Neurology
P11 - Poster Session 11 (8:00 AM-9:00 AM)
4-005
To discuss truncal myoclonus as a post-stroke movement disorder that can be associated with rare focal status epilepticus.
Myoclonus is classified by its source of generation: cortical, subcortical, spinal, or peripheral. Post-stroke movement disorders are typically due to lesions of the basal ganglia and thalamus but only occur 4% of the time. Post-stroke myoclonus is much rarer.
A 55-year-old female with history of right MCA stroke one year prior and subsequent right frontal focal seizures presented with left hand twitching. EEG demonstrated right centro-temporal sharp waves with lateralized periodic discharges. She was started on carbamazepine with resolution of hand twitching and normalization of the EEG, without further epileptiform discharges. However, she developed myoclonic jerks of her abdomen without alteration in consciousness. The myoclonus was present at rest, improved during sleep, and not painful. Brain MRI demonstrated encephalomalacia of old stroke. MRI C-spine, T-spine, and repeat EEG were normal. Carbamazepine was discontinued due to worsening truncal myoclonus. Valproic acid was started with significant improvement.
Our patient had features that may mimic other etiologies of truncal myoclonus such as Lance-Adams, diaphragmatic flutter, and propriospinal myoclonus. However, she did not have post-anoxic injury, respiratory symptoms, or spinal abnormalities. The truncal myoclonus was likely secondary to her underlying stroke and therefore cortical. When post-stroke myoclonus persists it may be a rare variant of focal status epilepticus. In the future, electromyography would be useful to confirm specific pathophysiology.
The underlying pathology of post-stroke myoclonus is due to dysfunction in GABA inhibitory neurotransmission. It can be challenging to diagnose myoclonus in patients who have concurrent focal epilepsy from underlying stroke. It is most important to determine physiology since this dictates treatment: carbamazepine may worsen myoclonus; clonazepam is effective in all forms of myoclonus; valproic acid and levetiracetam are effective for cortical myoclonus, but not other forms.
Authors/Disclosures
Faraze Niazi
PRESENTER 		Ms. Niazi has nothing to disclose.
Jessica Frey, MD (West Virginia University) The institution of Dr. Frey has received research support from Tourette Association of America.
Meghana Raghavan, MBBS (UW Medicine - Valley Medical Center) No disclosure on file
Ann Murray, MD (West Virginia Department of Neurology) Dr. Murray has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Insightec. Dr. Murray has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Medtronic .