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Abstract Details

COVID-19 Associated Diffuse Myoclonus and Dystonia (CADMAD) Syndrome: An Immune Mediated Para-Infectious or Post-Infectious Condition?
Movement Disorders
Movement Disorders Posters (7:00 AM-5:00 PM)
004

To present two patients with COVID-19 and diffuse myoclonic disorder.

Neurological manifestations associated with COVID-19 are being increasingly reported in the literature. However, diffuse myoclonic disorder associated with COVID-19 is rarely reported.

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Two young women, 22 and 33 years old, presented with uncontrollable muscle jerks involving the torso, neck, and extremities; dystonic posturing in the extremities or neck; and anosmia. Both were diagnosed with COVID-19 three to four weeks before presentation. However, the 22-year-old remained positive and the 33-year-old was negative at presentation. Their myoclonus was triggered by voice and worsened with intention and action but decreased while laying quietly and stopped during sleep. Both were taking psychoactive medications for years without side effects. Strength, reflexes, and plantar response were normal, as were labs. CSF analysis was normal for the 33-year-old. LP was not performed in the 22-year-old due to increased risk of CSF leaks in patients with Ehlers Danlos syndrome. Non-contrast MRI brain was normal in both. All medications with potential interactions were discontinued. Both were given IV fluids and cyproheptadine without improvement. A hyper-serotonergic state and all other causes of myoclonus were ruled out. Both were started on high dose intravenous methylprednisolone, clonazepam, and IVIG. The 33-year-old exhibited dramatic resolution of her myoclonus by the end of the treatment. The 22-year-old developed bradycardia, prompting discontinuation of methylprednisolone and clonazepam. She had modest improvement after completing IVIG but by discharge had near complete resolution of her myoclonus.

Diffuse myoclonic disorder should be recognized as a potential neurological complication of COVID-19. We suggest the name, COVID-19 Associated Diffuse Myoclonus and Dystonia (CADMAD) syndrome. Given the prompt response to immune-based therapy, it is hypothesized this syndrome could be a para-infectious or post-infectious immune-mediated disorder. Our report adds to the available literature to help with understanding and treatment of this disease.

Authors/Disclosures
Saleem M. Al Mawed, MD
PRESENTER
Dr. Al Mawed has nothing to disclose.
Sean T. Kenniff, MD (Memorial Neuroscience Institute) Dr. Kenniff has nothing to disclose.
Samir S. Al-Ghazawi, MD (ECU health Medical Center) Dr. Al-Ghazawi has nothing to disclose.
No disclosure on file
Mohammed Qureshi, MD Dr. Qureshi has nothing to disclose.