Isolated transient myoclonus in the elderly: an under-recognized condition?

Abstract

BACKGROUND:

Cases of transient myoclonus without other neurological manifestations in the elderly have very rarely been reported.

OBJECTIVE:

To report clinical features of elderly people with isolated transient myoclonus.

METHODS:

Clinical and laboratory features of 11 consecutive patients with isolated transient myoclonus (six men and five women; mean age, 75 years) were reviewed. Transient myoclonus was defined as an acute onset of tremulous myoclonus with/without asterixis in adults without other neurological symptoms.

RESULTS:

Preceding infections were recorded in five patients (pneumonia, two; upper respiratory tract infection, two; and septic arthritis of the shoulder, one). Myoclonus predominantly affected the head and/or neck (n=10) and upper extremities (n=11), compared with the trunk (n=2) and lower extremities (n=6). Asterixis was observed in six patients. Laboratory testing, neuroimaging, and electroencephalograms revealed no specific abnormalities. With or without treatment using benzodiazepines, myoclonus in all patients resolved completely within 1-4 days, although five had recurrence 2-19 months after their first episodes. Among these five patients, the accompanying asterixis patterns (presence or not) in four were different in the first and subsequent episodes.

CONCLUSIONS:

Isolated transient myoclonus with or without asterixis may be more common than generally believed, and it could be a clinical entity or disease spectrum. Transient myoclonus is a benign condition in the elderly, but can be under-reported or misdiagnosed. Therefore, it is important to recognize that the elderly may have this syndrome.

• Authors: Akiyuki Hiraga, Ikuo Kamitsukasa, Satoshi Kuwabara
• Journal: Clinical neurology and neurosurgery (Clin Neurol Neurosurg) Vol. 117 Pg. 51-54 (Feb 2014) ISSN: 1872-6968 [Electronic] Netherlands
• PMID: 24438805 (Publication Type: Journal Article)
• Copyright: Copyright © 2013 Elsevier B.V. All rights reserved.

Chemical References

• Anticonvulsants
• Benzodiazepines

Topics

• Aged (psychology)
• Aged, 80 and over
• Anticonvulsants (therapeutic use)
• Benzodiazepines (therapeutic use)
• Dyskinesias (etiology)
• Electroencephalography
• Female
• Humans
• Male
• Middle Aged
• Myoclonus (diagnosis, etiology)
• Neuroimaging
• Recurrence