Spinal myoclonus complicating spasticity in spinal cord injury: a case study.
A case of spinal myoclonus that complicated spasticity management is presented. A 37-year-old man with a C6 American Spinal Injury Association class B spinal cord injury was referred for treatment of spasticity. He had failed previous treatments with baclofen and dantrolene but was partly relieved by diazepam, although with unacceptable side effects. Further evaluation, including simultaneous electroencephalogram, videotaping, and electromyography of the quadriceps, anterior tibialis, posterior tibialis, and medial hamstring suggested myoclonic jerks of spinal origin that initiated episodes of unsustained clonus. During the worst episodes, myoclonic jerks came once every 16 to 22 seconds and persisted for 4 to 5 hours. Each episode of clonus lasted approximately 4 to 6 seconds. Treatment with valproic acid greatly diminished the frequency of myoclonic jerks with minimal side effects. Functionally, the patient was much less fatigued and better able to maintain his full time employment.
Andary
M T
MT
Department of Physical Medicine and Rehabilitation, College of Osteopathic Medicine, Michigan State University, East Lansing, USA.
Green
D F
DF
Hulce
V D
VD
Pysh
J J
JJ
D000203:Activities of Daily Living; D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004569:Electroencephalography; D004576:Electromyography; D006801:Humans; D008297:Male; D009125:Muscle Relaxants, Central / Q000627:therapeutic use; D009128:Muscle Spasticity / Q000188:drug therapy / Q000209:etiology*; D009207:Myoclonus / Q000188:drug therapy / Q000209:etiology*; D013119:Spinal Cord Injuries / Q000150:complications*; D013997:Time Factors; D014635:Valproic Acid / Q000627:therapeutic use
D000927:Anticonvulsants; D009125:Muscle Relaxants, Central; D014635:Valproic Acid