Post-Anoxic Reticular Reflex Myoclonus in a Child & Proposed Classification of Post-Anoxic Myoclonus

Publication date: Available online 7 January 2017
Source:Pediatric Neurology
Author(s): Min Tsui Ong, Ptolemaios Georgios Sarrigiannis, Peter Stuart Baxter
ObjectiveTo describe a childhood case of post-anoxic myoclonus of the reticular reflex type and discuss the classification of post-anoxic myoclonus.ResultsA 9 year old boy with severe hypoxic-ischemic encephalopathy due to submersion developed early epileptic spasms followed by stimulus sensitive multifocal generalised myoclonus and later dystonia. Video EMG (electromyography) polygraphy performed before treatment showed the discharges associated with the myoclonus lasted less than 50ms. Cortical myoclonus was excluded by jerk-locked averaging (JLA) using arm muscles, which showed no cortical correlates. The recruitment order on EMG polygraphy was consistent with a brainstem generator for the myoclonus, characteristic of reticular reflex myoclonus. Both myoclonus and dystonia responded to Clonazepam. He has remained in a persistent vegetative state.ConclusionReticular reflex myoclonus can be demonstrated by detailed neurophysiological assessment in children as in adults, and has a similar poor prognosis. Post-anoxic myoclonus can have several differing mechanisms and should not be considered synonymous with Lance-Adams myoclonus.



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