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Abstract Details

Improvement in Cortical Myoclonus in a Patient with VIM Deep Brain Stimulation for Essential Tremor
Movement Disorders
P07 - (-)
202
BACKGROUND: Myoclonus is a sudden, brief, involuntary jerking caused by abrupt muscle contraction (positive myoclonus) or discontinuation of ongoing muscular activity (negative myoclonus). Its pathophysiology is incompletely understood, though cerebellar influences on cortical excitability have been suggested. Case reports have described improvement in anoxic myoclonus after pallidal and thalamic DBS.
DESIGN/METHODS: An 85-year old right-handed man with coronary artery disease, COPD and essential tremor treated with left VIM DBS since 2003 developed disabling, multi-focal, spontaneous and action-induced positive and negative myoclonus in all extremities in the context of acute on chronic renal failure, worsening hypercapnia, and high-dose gabapentin therapy (1200mg/day). Myoclonus prevented safe ambulation and impaired activities of daily living. Clinical evaluation of tremor and myoclonus in stimulation OFF and ON conditions was performed.
RESULTS: DBS settings: 0(-) 1(+) 3.7 V 150 [micro]sec 185 Hz. With DBS OFF, there was frequent myoclonus of the tongue and arms more than legs. Postural and action tremor were moderate on the left and mild on the right. There was profound negative myoclonus upon standing and inability to ambulate. Handwriting was illegible. Spirals were severely impaired because of tremor and myoclonus. Water pouring was severely impaired, L>R, secondary to myoclonus. With DBS ON, myoclonus frequency and amplitude improved, R>L. Right postural tremor resolved. He could walk several steps without assistance. Handwriting, spirals and pouring on the right dramatically improved. Pouring on the left improved but not completely. Tremor Research Group (TRG) scales OFF and ON were 31.5 and 16.5, showing a 47.6% reduction with stimulation.
CONCLUSIONS: This case report suggests that modulation of cerebello-thalamo-cortical loops can improve myoclonus and provides insight into mechanisms underlying myoclonus.
Authors/Disclosures
Melissa Kagnoff, MD, MPH
PRESENTER 		No disclosure on file
Joohi Jimenez Shahed, MD, FAAN (Icahn School of Medicine at Mount Sinai) Dr. Jimenez Shahed has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Teva. Dr. Jimenez Shahed has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Medtronic. Dr. Jimenez Shahed has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. Dr. Jimenez Shahed has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amneal. Dr. Jimenez Shahed has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for BlueRock. Dr. Jimenez Shahed has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Treefrog. Dr. Jimenez Shahed has received personal compensation in the range of $500-$4,999 for serving as a Consultant for RebrAIn. Dr. Jimenez Shahed has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for BlueRock Therapeutics. Dr. Jimenez Shahed has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for PhotoPharmics. Dr. Jimenez Shahed has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Emalex. Dr. Jimenez Shahed has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biohaven. The institution of Dr. Jimenez Shahed has received research support from Amneal. The institution of Dr. Jimenez Shahed has received research support from Annovis. The institution of Dr. Jimenez Shahed has received research support from SAGE. The institution of Dr. Jimenez Shahed has received research support from Ono Pharmaceuticals. The institution of Dr. Jimenez Shahed has received research support from BlueRock. The institution of Dr. Jimenez Shahed has received research support from Neuron23. Dr. Jimenez Shahed has received personal compensation in the range of $0-$499 for serving as a Faculty with Movement Disorders Society. Dr. Jimenez Shahed has received personal compensation in the range of $500-$4,999 for serving as a Faculty with 好色先生. Dr. Jimenez Shahed has received personal compensation in the range of $500-$4,999 for serving as a Grant Reviewer with Parkinson Foundation.
No disclosure on file