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• W4361244963 abstract "SARS-CoV-2; Vaccination; Myoclonic status; EEG; COVID-19; Seizure SARS-CoV-2; Vaccination; Myoclonic status; EEG; COVID-19; Seizure We read with interest the article by Ben Mohamed et al. about a 60 years-old male with an uneventful previous history who developed non-epileptic myoclonus status five days after a SARS-CoV-2 vaccination [[1]Ben Mohamed D. Zouari R. Ketata J. Nabli F. Blel S. Ben Sassi S. Myoclonus status revealing COVID 19 infection.Seizure. 2022; 104: 12-14https://doi.org/10.1016/j.seizure.2022.11.010Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar]. He also tested positive for SARS-CoV-2 without showing any pulmonary or gastro-intestinal symptoms of the infection [[1]Ben Mohamed D. Zouari R. Ketata J. Nabli F. Blel S. Ben Sassi S. Myoclonus status revealing COVID 19 infection.Seizure. 2022; 104: 12-14https://doi.org/10.1016/j.seizure.2022.11.010Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar]. Myoclonus status has been attributed to the asymptomatic SARS-CoV-2 infection but not to SARS-CoV-2 vaccination [[1]Ben Mohamed D. Zouari R. Ketata J. Nabli F. Blel S. Ben Sassi S. Myoclonus status revealing COVID 19 infection.Seizure. 2022; 104: 12-14https://doi.org/10.1016/j.seizure.2022.11.010Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar]. The patient benefited from dexamethasone, plus clonazepam and levetiracetam [[1]Ben Mohamed D. Zouari R. Ketata J. Nabli F. Blel S. Ben Sassi S. Myoclonus status revealing COVID 19 infection.Seizure. 2022; 104: 12-14https://doi.org/10.1016/j.seizure.2022.11.010Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar]. The study is impressive but raises concerns that warrant further discussion. The main limitation of the study is that myoclonus status was attributed to the asymptomatic SARS-CoV-2 infection but not to the vaccination [[1]Ben Mohamed D. Zouari R. Ketata J. Nabli F. Blel S. Ben Sassi S. Myoclonus status revealing COVID 19 infection.Seizure. 2022; 104: 12-14https://doi.org/10.1016/j.seizure.2022.11.010Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar]. Isolated myoclonus and opsoclonus myoclonus syndrome has been reported both in connection with SARS-CoV-2 infections [[2]Finsterer J. Scorza F. Opsoclonus myoclonus ataxia (Kinsbourne, dancing eye-dancing feet) syndrome due to SARS-CoV-2.Neuro-Ophthalmol. 2022; (in press)PubMed Google Scholar,[3]Dijkstra F. Van den Bossche T. Willekens B. Cras P. Crosiers D. Myoclonus and cerebellar ataxia following COVID-19.Mov Disord Clin Pract. 2020; 7: 974-976https://doi.org/10.1002/mdc3.13049Crossref PubMed Scopus (39) Google Scholar] and after SARS-CoV-2 vaccinations [[4]Maramattom B.V. Lotlikar R.S. Sukumaran S. Central nervous system adverse events after ChAdOx1 vaccination.Neurol Sci. 2022; 43: 3503-3507https://doi.org/10.1007/s10072-022-06000-3Crossref PubMed Scopus (8) Google Scholar]. We therefore disagree with the notion that SARS-CoV-2 vaccination could not be responsible for myoclonus status [[1]Ben Mohamed D. Zouari R. Ketata J. Nabli F. Blel S. Ben Sassi S. Myoclonus status revealing COVID 19 infection.Seizure. 2022; 104: 12-14https://doi.org/10.1016/j.seizure.2022.11.010Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar]. Another argument for vaccination is the temporal relation between vaccination and the onset of myoclonus. The fact that the infection remained asymptomatic in the respiratory tract and the intestines speaks against the infection as a cause. Another limitation of the study is that it does not mention whether cerebral magnetic resonance imaging (MRI) was performed with or without contrast agent. The use of contrast media is crucial as it can show focal or diffuse enhancement in the case of immune-encephalitis. Encephalitis may be present despite normal routine cerebrospinal fluid (CSF) parameters. It would be interesting to know whether antibodies related to autoimmune encephalitis have also been tested in the CSF. These antibodies can be negative in serum but positive in CSF. It would also be interesting to know whether the CSF was tested for cytokines, chemokines, glial markers, or 14-3-3. These parameters may be elevated in patients with central nervous system (CNS) involvement in a SARS-CoV-2 infection or after SARS-CoV-2 vaccination. Although unlikely, we should know whether multisystem inflammatory syndrome in adults (MIS-A) is a possible cause of myoclonus. Overall, the study has some limitations that require reassessment and discussion. Clarifying these weaknesses would strengthen the conclusions and could make the study even more interesting. Non-epileptic myoclonus status can be due to SARS-CoV-2 infections and SARS-CoV-2 vaccinations. Only secondary data were used. Not applicable. Not applicable. All data are available from the corresponding author. Not applicable. JF: design, literature search, discussion, first draft, critical comments, final approval," @default.
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• W4361244963 title "Non-epileptic myoclonus status can be due to both SARS-CoV-2 infection and SARS-CoV-2 vaccination" @default.
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