Generalized myoclonus in COVID-19
Pablo Rábano-Suárez, Laura Bermejo-Guerrero, Antonio Méndez-Guerrero, Javier Parra-Serrano, Daniel Toledo-Alfocea, Daniel Sánchez-Tejerina, Teresa Santos-Fernández, María Dolores Folgueira-López, Judit Gutiérrez-Gutiérrez, Blanca Ayuso-García, Jesús González de la Aleja, Julián Benito-León, Pablo Rábano-Suárez, Laura Bermejo-Guerrero, Antonio Méndez-Guerrero, Javier Parra-Serrano, Daniel Toledo-Alfocea, Daniel Sánchez-Tejerina, Teresa Santos-Fernández, María Dolores Folgueira-López, Judit Gutiérrez-Gutiérrez, Blanca Ayuso-García, Jesús González de la Aleja, Julián Benito-León
Abstract
Objective: To report 3 patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who developed generalized myoclonus.
Methods: Patient data were obtained from medical records from the University Hospital "12 de Octubre," Madrid, Spain.
Results: Three 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.
Conclusions: Our 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.
© 2020 American Academy of Neurology.
Source: PubMed