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Abstract Details

Drug-induced Myoclonus in a Patient on Continuous Dobutamine Infusion
Movement Disorders
Movement Disorders Posters (7:00 AM-5:00 PM)
039
To report a rare case of generalized myoclonus in the setting of dobutamine infusion for systolic heart failure.
Drug-induced myoclonus can present challenging diagnostic and management obstacles, especially in the setting of polypharmacy and medical comorbidities. Many medications have been described to cause symptomatic myoclonus; however dobutamine has only rarely been associated with this side effect.
A 71 year-old male with a history of CKD (GFR 60-90), DM type II, depression, atrial fibrillation, chronic hypotension, and severe systolic heart failure presented with nonrhythmic myoclonic movements affecting the face, oropharynx, arms, torso, and legs within 24 hours of initiating continuous dobutamine infusion therapy. Neurological exam was otherwise unremarkable. EEG showed normal electrographic activity. Levetiracetam 2500 mg IV was given, with moderate improvement. Myoclonus resolved after dobutamine infusion was stopped and its administration route was later changed from a PICC line to peripheral IV infusion.
One prior case report implicates dobutamine infusion and myoclonus in a patient with end-stage renal disease at an infusion rate of 3 μg/kg/min; the symptoms lasted for 3 weeks before subsiding spontaneously. Our patient was initially placed on a dobutamine infusion rate of 5 μg/kg/min. No changes in baseline creatinine levels (0.8-1.1) were seen preceding or during admission. His medications also included gabapentin and sertraline, which have been previously implicated in drug-induced myoclonus; however no changes to these medications were made preceding or during admission. Dobutamine infusion was resumed prior to discharge with no return of myoclonus, even at 2 months when patient seen for PICC line revision.
Dobutamine infusion has rarely been associated with generalized myoclonus. Adjusting infusion rate or route of administration may help ameliorate symptoms. Levetiracetam may also be useful for symptomatic treatment in patients where the infusion cannot be adjusted or stopped.
Authors/Disclosures
Mario P. Zamora
PRESENTER 		Dr. Zamora has nothing to disclose.
Danielle S. Shpiner, MD An immediate family member of Dr. Shpiner has received personal compensation for serving as an employee of University of Miami. Dr. Shpiner has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Mission MSA. The institution of Dr. Shpiner has received research support from American Parkinson's Disease Association. The institution of Dr. Shpiner has received research support from CurePSP. The institution of Dr. Shpiner has received research support from Parkinson's Foundation. Dr. Shpiner has a non-compensated relationship as a COE Medical Director with Parkinson's Foundation that is relevant to Â鶹´«Ã½Ó³»­ interests or activities. Dr. Shpiner has a non-compensated relationship as a Fellowship Co-Director with Medtronic that is relevant to Â鶹´«Ã½Ó³»­ interests or activities. Dr. Shpiner has a non-compensated relationship as a Fellowship Co-Director with Boston Scientific that is relevant to Â鶹´«Ã½Ó³»­ interests or activities. Dr. Shpiner has a non-compensated relationship as a Fellowship Co-Director with Abbott that is relevant to Â鶹´«Ã½Ó³»­ interests or activities. Dr. Shpiner has a non-compensated relationship as a Fellowship Co-Director with Abbvie that is relevant to Â鶹´«Ã½Ó³»­ interests or activities. Dr. Shpiner has a non-compensated relationship as a Fellowship Co-Director with Ipsen that is relevant to Â鶹´«Ã½Ó³»­ interests or activities. Dr. Shpiner has a non-compensated relationship as a Fellowship Co-Director with Amneal that is relevant to Â鶹´«Ã½Ó³»­ interests or activities. Dr. Shpiner has a non-compensated relationship as a Fellowship Co-Director with Michael J. Fox Foundation that is relevant to Â鶹´«Ã½Ó³»­ interests or activities. Dr. Shpiner has a non-compensated relationship as a CoC Medical Director with CurePSP that is relevant to Â鶹´«Ã½Ó³»­ interests or activities. Dr. Shpiner has a non-compensated relationship as a COE Medical Director with Mission MSA that is relevant to Â鶹´«Ã½Ó³»­ interests or activities. Dr. Shpiner has a non-compensated relationship as a Fellowship Co-Director with Merz that is relevant to Â鶹´«Ã½Ó³»­ interests or activities.