1113 - A Case of Atypical Propriospinal Myoclonus Following Spinal Cord Cavernoma Resection

19-year-old female patient who presented with uncontrollable extremity involuntary movements occurring without triggers or loss of consciousness. EEG done ruled out seizures and cervical spine MRI demonstrated a spinal cord cavernoma. Following cavernoma resection, the patient was admitted to acute inpatient rehabilitation, where she persisted with episodes of involuntary movements involving mostly upper extremities. The episodes each lasted 30-40 minutes and occurred both during the day and night. Post-operatively, she was treated with midazolam for acute episodes, as well as scheduled levetiracetam and clonazepam. Due to persistence of such episodes, the patient was then switched to valium and gabapentin per Neurology recommendations. This resulted in a decreased frequency of episodes to once a day allowing the patient to be discharged home. 

 

Discussions:

Management of propriospinal myoclonus lacks significant supportive evidence in the literature with no clear guidelines provided at this point in time. Reports have discussed a proposed first-line treatment with clonazepam, as it was shown effective in 34 of 65 cases. Other treatment options reported effective in sporadic cases include botulinum toxin, SSRIs, levetiracetam, and valproate with varying success rates. While this patient treated with valium showed improvement, to this date there is not substantial evidence supporting the effectiveness of one treatment compared to others in order to develop clear guidelines.  

 

Conclusions:

This case adds to the small number of reports of treated propriospinal myoclonus. We present the use of valium as a possible treatment option for patients presenting similarly. With this in mind, there remains a need for future structured studies to determine the most effective treatment measures and develop guidelines for treating this condition.