Spasticity / Movement Disorders
Akhil Golla, MD
PMR resident
Moss Rehab
Bridgewater, New Jersey, United States
Dhruti Patel, MD
Resident Physician
Jefferson Moss-Magee Rehabilitation
Bala Cynwyd, Pennsylvania, United States
Shahrear Ahmed, DO
Resident Physician
Jefferson Moss-Magee Rehabilitation Hospital
Philadelphia, Pennsylvania, United States
Daniel Moon, MD, MS
Director of Neuromodulation
Jefferson Moss Magee Rehab
Elkins Park, Pennsylvania, United States
Akhil Golla, MD
Moss Rehab
Bridgewater, New Jersey, United States
A 70-year-old male with history of atrial fibrillation presented following recurrent falls, found to have bilateral chronic subdural hematomas. He underwent bilateral middle meningeal artery embolization, followed by left craniotomy and burr hole evacuation. He was discharged to Inpatient Rehab where he developed persistent, rhythmic abdominal wall contractions consistent with segmental abdominal myoclonus and disruptive to sleep and function. Dynamic surface electromyography (EMG) revealed repetitive bursts (0.6 Hz) primarily in the obliques and rectus abdominis.
After discharge home, he continued to suffer progressive ambulation intolerance, ultimately requiring a wheelchair for mobility, significant sleep disturbance, contracture, and depression. He was trialed on numerous medications including clonazepam, ropinirole, baclofen, tizanidine, levetiracetam, and botulinum toxin injections without relief. Intrathecal baclofen trial showed reduced frequency of spasms but excessive sedation. Proceeding with ITB pump implantation and titration yielded marked symptomatic improvement with dose titration of 78.8 mcg/day. Repeat surface EMG demonstrated absence of myoclonus.
Discussions: Segmental abdominal myoclonus, also known as belly dancer’s dyskinesia, is a rare, often disabling movement disorder characterized by involuntary rhythmic abdominal muscle contractions. The condition is often refractory to oral pharmacotherapy and chemodenervation. Dynamic surface EMG was instrumental in confirming diagnosis. ITB pumps have shown efficacy in treating global spasticity, dystonia, and myoclonus, likely through GABA-B receptor agonism in the spinal cord.
Conclusions: This case highlights the utility of surface dynamic EMG in diagnosing abdominal myoclonus and potential for treatment with intrathecal baclofen therapy. ITB therapy should be considered in refractory cases of segmental myoclonus unresponsive to oral and focal therapies.
