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- W917414149 abstract "Objective Post-hypoxic myoclonus can be classified in various ways, including acute and chronic (Lance-Adams) forms. We present the first childhood case of post-anoxic reticular reflex myoclonus and discuss the classification. Case A previously healthy 9 year old boy developed severe hypoxic-ischaemic encephalopathy and transient multi-organ injury following 10 minutes of cold water immersion and subsequent resuscitation. Initial GCS was 3. On day 3 he developed spasms and was treated with Phenytoin and Midazolam infusion. His EEG showed burst of spikes/polyspikes and sharp waves interspersed with relative suppression. MRI demonstrated focal signal change involving caudate nuclei and parafalcine parietal lobes bilaterally. This later evolved to volume loss with gliosis. He had multifocal and generalised myoclonus, present from day 7, which was stimulus sensitive. On day 17 he developed dystonic spasms, evolving into status dystonicus which was treated with several medications including Clonazepam. Myoclonus stopped by day 29, 6 days following introduction of Clonazepam. By day 90 spasms resolved and Clanazepam withdrawn. Myoclonus re-emerged at 5 months. He was minimally conscious on weeks 3 and 7 but subsequent coma recovery scores were compatible with a persistent vegetative state. Results Video EMG polygraphy performed (day 22) showed the discharges associated with the myoclonus were very short, below 50 ms. The possibility of cortical myoclonus, assessed by jerk-locked back averaging using arm muscles, showed no cortical correlates. The recruitment order on EMG polygraphy was consistent with a brainstem generator for the myoclonus (rostral and caudal spread from a lower brain stem lead) which is characteristic of reticular reflex myoclonus (Hallet, 2000). Conclusion Post-anoxic myoclonus should not be considered synonymous with Lance-Adams myoclonus. The terms early or late are poorly defined. It is clinically more useful to classify post-anoxic myoclonus into cortical and subcortical, and to subdivide the cortical form into acute and chronic (Lance-Adams) forms." @default.
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- W917414149 date "2015-05-01" @default.
- W917414149 modified "2023-09-27" @default.
- W917414149 title "OP63 – 2453: Post-anoxic reticular reflex myoclonus in a child" @default.
- W917414149 doi "https://doi.org/10.1016/s1090-3798(15)30064-7" @default.
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