Reticular Myoclonus: It Really Comes From the Brainstem!

Beudel, Martijn; Elting, Jan Willem J.; Uyttenboogaart, Maarten; Broek, Mariska W.C. van den; Tijssen, Marina A. J.

doi:10.1002/mdc3.12054

Cited by 13 publications

(7 citation statements)

References 11 publications

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“…19 In this particular sequence, Electromyographic discharges are first seen in the lower brain stem musculature and subsequently in the upper brain stem musculature followed by discharges spreading downward to muscles innervated in the spinal cord. 20 Based on the present data, we can only speculate about the etiology of the putative co-occurrence of cortical and subcortical phenomenon in generalized PHM. One possible explanation is that cases with both generalized SE and generalized PHM had severe cortical and subcortical damage.…”

Section: Myoclonus and Eeg Characteristicsmentioning

confidence: 67%

Electroencephalographic Findings in Posthypoxic Myoclonus

Zijl

Beudel

Hoeven

et al. 2015

J Intensive Care Med

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The physical examination findings of early posthypoxic myoclonus (PHM) are associated with poor prognosis. Recent findings indicate that patients with multifocal PHM, assumed to have a cortical origin, have a comparable outcome to resuscitated patients without PHM. Generalized PHM, assumed to have a subcortical myoclonus origin, is still associated with a bad clinical outcome. It is not known whether the electroencephalographic (EEG) findings differ between the multifocal and generalized myoclonus groups nor is the clinical significance clearly defined. Forty-three patients with PHM were retrospectively derived from an EEG database. Patients were categorized as having multifocal (i), generalized (ii), or undetermined (iii) PHM. Outcome was expressed in cerebral performance category scores. The EEG background was categorized into isoelectric (I), low voltage (II), burst suppression (III), status epilepticus (SE; IV), diffuse slowing (V), and mild encephalopathic or normal (VI). 17 patients had generalized PHM and 23 had multifocal PHM (3 undetermined). The EEG showed more SE in generalized compared to multifocal PHM (64% vs 13%, P< .001). Diffuse slowing was more often present in multifocal PHM (52% vs 17%, P < .05). Early-onset myoclonus occurred significantly more often in generalized PHM, and early generalized PHM was invariantly associated with poor outcome. In conclusion, patients with generalized PHM showed more SE. These EEG findings might be either subcortical corollaries or primarily cortical phenomena. Our retrospective results conflict with currently used clinical criteria for myoclonus classification, and we suggest that more refined difference may be needed for accurate assessment of PHM. To better understand PHM, prospective research with standardized clinical assessment and quantitative EEG analysis is needed.

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Section: Myoclonus and Eeg Characteristicsmentioning

confidence: 67%

Electroencephalographic Findings in Posthypoxic Myoclonus

Zijl

Beudel

Hoeven

et al. 2015

J Intensive Care Med

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“…Jerking movements of our patients could be attributable to brainstem myoclonus, a type of myoclonus originating from the lower brainstem, which is characterized by initial muscle activation in muscles innervated in the lower brainstem followed by a sequence of both higher brainstem innervated muscles and muscles innervated further down the spinal cord. 8 Worsening of myoclonus with movements, tactile stimuli, and specially the exaggerated startle response also support this hypothesis. 8 EEG studies performed ruled out an epileptic myoclonus, but further neurophysiologic (i.e., EMG) tests could not be performed due to logistic limitations in the setting of the current pandemic.…”

Section: Discussionmentioning

confidence: 89%

“…8 Worsening of myoclonus with movements, tactile stimuli, and specially the exaggerated startle response also support this hypothesis. 8 EEG studies performed ruled out an epileptic myoclonus, but further neurophysiologic (i.e., EMG) tests could not be performed due to logistic limitations in the setting of the current pandemic.…”

Section: Discussionmentioning

confidence: 89%

Generalized myoclonus in COVID-19

et al. 2020

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ObjectiveTo report 3 patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who developed generalized myoclonus.MethodsPatient data were obtained from medical records from the University Hospital “12 de Octubre,” Madrid, Spain.ResultsThree patients (2 men and 1 woman, aged 63–88 years) presented with mild hypersomnia and generalized myoclonus following the onset of the so-called inflammatory phase of coronavirus disease 2019 (COVID-19). All of them had presented previously with anosmia. Myoclonus was generalized with both positive and negative jerks, predominantly involving the facial, trapezius, sternocleidomastoid, and upper extremities muscles. These myoclonic jerks occurred spontaneously and were extremely sensitive to multisensory stimuli (auditive and tactile) or voluntary movements, with an exaggerated startle response. Other causes of myoclonus were ruled out, and none of the patients had undergone respiratory arrest or significant prolonged hypoxia. All of them improved, at least partially, with immunotherapy.ConclusionsOur 3 cases highlight the occurrence of myoclonus during the COVID-19 pandemic as a post- or para-infectious immune-mediated disorder. However, we cannot rule out that SARS-CoV-2 may spread transneuronally to first- and second-order structures connected with the olfactory bulb. Further investigation is required to clarify the full clinical spectrum of neurologic symptoms and optimal treatment.

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“…[ 5 ] The characteristic electrophysiological feature in multichannel EMG is early activation of muscles supplied by the cranial accessory nerve (sternocleidomastoid and trapezius) followed later by the spread in a rostro-caudal fashion to involve the muscles of the face, limbs, and trunk. [ 26 ] These discharges can be brief but are usually more than 100 ms in duration. Reticular reflex myoclonus is seen in hypoxic encephalopathy, uremia, viral encephalitis and demyelinating, neoplastic, or vascular lesions of the brainstem.…”

Section: N Europhysiological C Lassificationmentioning

confidence: 99%

Myoclonus- A Review

Chandarana

Saraf

Kajaria

et al. 2021

Annals of Indian Academy of Neurology

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Myoclonus is a hyperkinetic movement disorder characterized by a sudden, brief, involuntary jerk. Positive myoclonus is caused by abrupt muscle contractions, while negative myoclonus by sudden cessation of ongoing muscular contractions. Myoclonus can be classified in various ways according to body distribution, relation to activity, neurophysiology, and etiology. The neurophysiological classification of myoclonus by means of electrophysiological tests is helpful in guiding the best therapeutic strategy. Given the diverse etiologies of myoclonus, a thorough history and detailed physical examination are key to the evaluation of myoclonus. These along with basic laboratory testing and neurophysiological studies help in narrowing down the clinical possibilities. Though symptomatic treatment is required in the majority of cases, treatment of the underlying etiology should be the primary aim whenever possible. Symptomatic treatment is often not satisfactory, and a combination of different drugs is often required to control the myoclonus. This review addresses the etiology, classification, clinical approach, and management of myoclonus.

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Reticular Myoclonus: It Really Comes From the Brainstem!

Cited by 13 publications

References 11 publications

Electroencephalographic Findings in Posthypoxic Myoclonus

Electroencephalographic Findings in Posthypoxic Myoclonus

Generalized myoclonus in COVID-19

Myoclonus- A Review

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