Objective: To describe a case of propriospinal myoclonus (PM) in the setting of respiratory infection by SARS-CoV-2.

Background: PM is an uncommon movement disorder characterized by myoclonic jerks arising in muscles corresponding to a myelomere which spread rostrally and caudally to other myotomes. PM has not been previously reported in the setting of SARS-CoV-2 infection.

Method: Case report.

Results: A 63 years-old man was admitted to intensive care unit because of severe respiratory SARS-CoV-2 infection. Some infectious complications worsened the clinical course and prolonged the need of mechanical ventilation, without documented respiratory arrest. Forty days after admission to ICU, the patient began to manifest abnormal arrhythmic movements consisting in spontaneous flexion of the trunk, both in abdominal and cervical regions, after withdrawal of sedative drugs. Propofol, fentanyl and midazolam were resumed. Although there was a partial improvement of the movements, they were still present and triggered by auditory or tactile stimuli.
An electroencephalogram did not display epileptiform activity. Polymyography showed muscle contractions that started in supraumbilical muscles, followed by rostral and caudal spreading, supporting the clinical suspicion of PM. Cranial and spinal MRI and blood tests were normal. Clonazepam and levetiracetam achieved PM remission and allowed the withdrawal of sedation. Unfortunately, his general condition worsened and he died due to shock and respiratory failure.

Conclusion: We present the first case of propriospinal myoclonus in the context of SARS-CoV-2 infection. Clonazepam and levetiracetam in combination resulted in resolution of these movements.

References: 1. Paterson RW, Brown RL, Benjamin L, Nortley R, Wiethoff S, Bharucha T, et al. The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings. Brain. 2020;awaa240. 2. Mas Serrano M, Pérez-Sánchez JR, Portela Sánchez S, De La Casa-Fages B, Mato Jimeno V, Pérez Tamayo I, et al. Serotonin syndrome in two COVID-19 patients treated with lopinavir/ritonavir. J Neurol Sci. 2020;415:116944. 3. Radmanesh A, Derman A, Ishida K. COVID-19-associated delayed posthypoxic necrotizing leukoencephalopathy. J Neurol Sci. 2020;415:116945. 4. Benameur K, Agarwal A, Auld SC, Butters MP, Webster AS, Ozturk T, et al. Encephalopathy and Encephalitis Associated with Cerebrospinal Fluid Cytokine Alterations and Coronavirus Disease, Atlanta, Georgia, USA, 2020. Emerg Infect Dis [Internet]. 2020;26(9). 5. Ros‐Castelló V, Quereda C, López‐Sendón J, Corral I. Post‐hypoxic myoclonus after COVID ‐19 infection recovery. Mov Disord Clin Pract. 2020;mdc3.13025. 6. Rábano-Suárez P, Bermejo-Guerrero L, Méndez-Guerrero A, Parra-Serrano J, Toledo-Alfocea D, Sánchez-Tejerina D, et al. Generalized myoclonus in COVID-19. Neurology. 2020;10.1212/WNL.0000000000009829. 7. Roze E, Bounolleau P, Ducreux D, Cochen V, Leu-Semenescu S, Beaugendre Y, et al. Propriospinal myoclonus revisited: Clinical, neurophysiologic, and neuroradiologic findings. Neurology. 2009;72(15):1301–9. 8. Verma R, Praharaj HN, Raut TP, Rai D. Propriospinal myoclonus: is it always psychogenic? Case Rep. 2013 Jul 29;2013:bcr2013009559–bcr2013009559. 9. van der Salm SMA, Erro R, Cordivari C, Edwards MJ, Koelman JHTM, van den Ende T, et al. Propriospinal myoclonus: clinical reappraisal and review of literature. Neurology. 2014;83(20):1862–70. 10. Bedarf JR, Nelles M, Reimann J, Paus S, Zimmermann J. Teaching Video NeuroImages: Propriospinal myoclonus as a sequela of Guillain-Barré syndrome. Neurology. 2018;91(3):e297–9. 11. Walder B, Tramèr MR, Seeck M. Seizure-like phenomena and propofol: a systematic review. Neurology. 2002;58(9):1327–32.

« Back to MDS Virtual Congress 2021

MDS Abstracts - https://www.mdsabstracts.org/abstract/propriospinal-myoclonus-associated-to-sars-cov-2-respiratory-infection/