Reversible Myoclonus‐Ataxia as a Postinfectious Manifestation of COVID‐19

Schellekens, Mijntje M.I.; Bleeker‐Rovers, Chantal P.; Keurlings, Pim; Mummery, Catherine J.; Bloem, Bastiaan R.

doi:10.1002/mdc3.13088

Cited by 36 publications

(51 citation statements)

References 9 publications

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“…For those with no history of ataxia, the development of this condition secondary to COVID-19 is uncommon, with only 0.4% patients experiencing ataxia [ 134 ]. Case studies have reported ataxia developing prior to, during, and post COVID-19 in men aged 30 to 73 years [ [145] , [146] , [147] , [148] ]. Therapies ranged for patients, however, and included the use of levetiracetam in combination or alone to resolve the symptoms [ 146 , 147 ].…”

Section: Sars-cov-2 Infection Of the Nervous Systemmentioning

confidence: 99%

SARS-CoV-2 mediated neuroinflammation and the impact of COVID-19 in neurological disorders

Amruta

Chastain

Paz

et al. 2021

Cytokine & Growth Factor Reviews

106

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Section: Sars-cov-2 Infection Of the Nervous Systemmentioning

confidence: 99%

SARS-CoV-2 mediated neuroinflammation and the impact of COVID-19 in neurological disorders

Amruta

Chastain

Paz

et al. 2021

Cytokine & Growth Factor Reviews

106

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“…4 A postinfectious possibility is supported in the remaining 3 cases by the lack of other potential causes identified and the improvement after immunotherapy. [5][6][7] Interestingly, analysis of cerebrospinal fluid (CSF) revealed no pleocytosis and no SARS-CoV-2 RNA in these cases, suggesting an immunemediated pathogenesis. In 1 case there were signs of blood-brain barrier disruption together with elevated CSF interleukin-6 levels and increased interleukin-8 CSF/blood ratio involved in COVID-19 secondary hyperinflammation syndrome.…”

mentioning

confidence: 90%

“…3 cases [4][5][6] and sensitive to touch in 2 cases 5,7 and to auditory stimuli in 1 case. 7 Although in 2 cases myoclonus was isolated, 4,5 in the other 2 cases it was accompanied by cerebellar signs (such as saccadic intrusions, hypermetric saccades and ocular flutter on eye movement assessment, and ataxia) 6,7 ; 1 patient also had cognitive dysfunction. 7 Electrophysiological testing was performed in 1 case 5 and revealed a combination of long-duration electromyographic bursts with no sign of cortical discharges time locked to individual myoclonic jerks, consistent with a subcortical origin of the myoclonus.…”

mentioning

confidence: 99%

“…In 3 patients, myoclonus improved following treatment with clonazepam or levetiracetam, drugs that are typically effective in cortical myoclonus rather than subcortical or spinal myoclonus. [4][5][6] In 1 case, the authors suspected a postinfectious etiology and started treatment with steroids followed by immunoglobulin infusion with a good response 7 ; however, whether the improvement was related to a natural and self-limited evolution of the disease is not known.…”

mentioning

confidence: 99%

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Myoclonus and COVID‐19: A Challenge for the Present, a Lesson for the Future

Latorre

Rothwell

2020

Movement Disord Clin Pract

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, severe acute respiratory syndromecoronavirus type 2 (SARS-CoV-2), causing coronavirus disease 2019 (COVID-19), was first diagnosed in the city of Wuhan, in central China, and has since spread across the entire world. Although several countries have implemented measures to control the epidemic, because of the outbreak, on March 11, 2020, the World Health Organization declared the situation a pandemic. To date, confirmed cases are 28,584,158, and confirmed deaths are 916,955 (World Health Organization data, September 13, 2020). Compared with the genetically related to SARS-CoV (the first pandemic threat of a coronavirus that emerged in late 2002) and Middle East respiratory syndrome coronavirus (another coronavirus that is not currently presenting a pandemic threat), SARS-CoV-2 is less deadly but far more transmissible and with a broad clinical spectrum. 1 This has become soon evident by the severity range of the respiratory illness, from asymptomatic to critical, but more important, it has been demonstrated by the striking incidence of extrapulmonary manifestations. 2 In fact, although the most common symptoms of COVID-19 include fever, cough, shortness of breath, and a substantial pulmonary disease (from pneumonia to acute respiratory distress syndrome), SARS-CoV-2 appears to affect other organs, including the nervous system. Apart from the well-known reported anosmia and dysgeusia, other reported neurological manifestations include encephalopathies, para/postinfective central nervous system (CNS) syndromes, cerebrovascular diseases (ischemic and hemorrhagic), and the prototypic infection-triggered neurological autoimmune disease Guillain-Barré syndrome. 3 Nevertheless, a less expected and relatively unusual neurological complication has emerged as a consequence of COVID-19. In this issue of Movement Disorder Clinical Practice, 4 cases are reported in which myoclonus is the predominant, or almost isolated, clinical manifestation, following resolution of acute respiratory COVID-19 syndrome. 4-7 All cases presented with multifocal/generalized myoclonus, predominantly action induced, mostly involving the limbs and affecting walking. Myoclonus was positive and negative in

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“…COVID-19-associated immune activation in the olfactory system leading to alpha-synuclein misfolding and development of Parkinsonian features has been speculated in such cases [49,50]. Reports of COVID-19-associated other movement disorders including ocular flutter, opsoclonus, tremors, myoclonus, and ataxia have also been reported [47,77,78]. Most of them manifested in the second or third week of illness, making postinfectious or parainfectious autoimmune phenomenon the likely pathogenesis.…”

Section: Extrapyramidal Featuresmentioning

confidence: 99%