Hyperkinetic movement disorders following SARS-CoV-2 infection and vaccination — an update

Abstract

The aim of this review was to summarise current knowledge regarding hyperkinetic movement disorders related to SARS-CoV-2 infection and vaccination in terms of phenomenology, epidemiology, pathogenesis and treatment. After a thorough review of the PubMed and Google Scholar databases (2020-2022), we identified myoclonus and ataxia sometimes accompanied by opsoclonus (AMS) as the two most frequent COVID-19 sequelae, with chorea, tremor and dystonia being very rare. The pathogenesis seems to be variable, but in the majority of AMS cases it was autoimmunological, with good response and recovery after corticosteroids or intravenous immunoglobulins infusions. Vaccination may be complicated by hyperkinetic movement disorders (e.g. tremor, dystonia), but this is very rare. Patients with Deep Brain Simulation depletion should not be postponed due to lockdowns as this may result in fatal outcomes.

SARS-CoV-2 and the nervous system

“…However, as indicated in the article published in this issue [21], based on the analysis of publications that appeared up until the end of November, 2022, post-COVID-19 parkinsonism is very rare, and the described cases of parkinsonism, being temporally related to COVID-19, seem to have a very diverse aetiology. An analysis of the literature [22] indicates that the most common hyperkinetic movement disorders associated with a history of SARS-CoV-2 infection include myoclonus and ataxia, whereas chorea, tremor and dystonia are extremely rare. Interestingly, hyperkinetic disorders found after COVID-19 seem to have an autoimmune basis and respond well to treatment with glucocorticoids and immunoglobulins [23].…”

Meige Syndrome Following COVID Infection

“…The most reported movement disorder following a COVID infection is myoclonus. [4][5][6] Other commonly reported hyperkinetic movement disorders are ataxia and opsoclonus. 6 Few studies have reported the occurrence of other movement disorders such as blepharospasm and focal dystonia, but they are thought to be fairly rare.…”

“…[4][5][6] Other commonly reported hyperkinetic movement disorders are ataxia and opsoclonus. 6 Few studies have reported the occurrence of other movement disorders such as blepharospasm and focal dystonia, but they are thought to be fairly rare. 6 Three cases of blepharospasm have been reported with presentation occurring from 2 weeks to 4 months after the onset of symptomatic COVID infection.…”

“…6 Few studies have reported the occurrence of other movement disorders such as blepharospasm and focal dystonia, but they are thought to be fairly rare. 6 Three cases of blepharospasm have been reported with presentation occurring from 2 weeks to 4 months after the onset of symptomatic COVID infection. 7 One case of dystonia of the upper extremities was described following a symptomatic SARS-CoV-2 infection.…”

“…4,8 As for patients already having a diagnosis of dystonia and hemifacial spasm, 65 percent of them noted worsening of symptoms, mostly due to delays in botulinum toxin injections rather than the COVID infection itself. 5 Although the mechanism by which COVID may cause these neurological findings is not clear, most researchers speculate an underlying immunological cause, [4][5][6]8 such as molecular mimicry, especially since these cases seemed to respond well to immune therapies. 6 In asymptomatic or mildly symptomatic patients, structural damage and toxic or metabolic anomalies are less likely to explain the occurrence of movement disorders, making an immune-mediated cause even more persuasive.…”