Aim of study. The pandemic state of COVID-19 has resulted in new neurological post-infection syndromes. Recently, several papers have reported ataxia-myoclonus syndrome following SARS-CoV-2 infection. The aim of this study was to present our two cases and compare them to previously reported cases.Materials and methods. We present two video-accompanied new cases with ataxia-myoclonus syndrome following SARS--CoV-2 infection and discuss the studies published so far.Results. Ataxia-myoclonus syndrome, isolated myoclonus, opsoclonus-myoclonus syndrome as post-COVID-19 syndrome following infection have been described in 16 patients (including our two cases). Patients have been treated with intravenous immunoglobulins and/or steroids except for 4 patients, which resulted in a significant improvement within 1-8 weeks.Conclusions and clinical implications. The increasing number of patients with a similar symptomatology shows a significant relationship between COVID-19 infection and ataxia-myoclonus syndrome. The subacute onset of neurological symptoms after a resolved COVID-19 infection and prominent response to immunotherapy may suggest that the neurological manifestations are immune-mediated. Although recovery is highly possible, it may take several weeks/months, and clinicians should be aware of this diagnosis and the beneficial effects of immunological treatment administered as soon as possible.
Introduction. Deep brain stimulation (DBS) therapy for Parkinson's Disease (PD) and dystonia is associated with the possibility of both minor and major complications. One possible side effect is the depletion of implantable pulse generator (IPG) battery and the associated sudden recurrence of PD or dystonia symptoms, which can be potentially life-threatening. Delayed or postponed outpatient visits due to COVID -19 may be a risk factor of battery end-of-life consequences.Objective. To analyse the clinical outcomes in reported PD and dystonia patients treated with DBS, who, as a result of the sudden depletion of the neurostimulator battery, developed life-threatening symptoms.Materials and methods. The databases of PubMed, Scopus, EMBASE and Google Scholar were searched using pre-established criteria.Results. A total of 244 articles was found, of which 12 met the adopted criteria. Selected papers presented a total of 17 case reports of DBS-treated patients -11 with PD, and six with dystonia -who had depleted IPG batteries and due to rapid worsening of PD/dystonia symptoms required urgent hospital admission. IPG battery replacement was the only effective treatment in the majority of cases.Conclusions. IPG battery depletion can result in fatal outcomes. Sudden recurrence of PD or dystonia symptoms in patients treated by DBS can be potentially life-threatening, so scheduling the replacement of a discharged IPG battery should not be postponed. The COVID-19 pandemic should alert staff at emergency, neurology and movement disorders wards not to postpone the visits of patients with an implanted DBS system.
The aim of this review was to summarise current knowledge regarding hyperkinetic movement disorders related to SARS-CoV-2 infection and vaccination in terms of phenomenology, epidemiology, pathogenesis and treatment. After a thorough review of the PubMed and Google Scholar databases (2020-2022), we identified myoclonus and ataxia sometimes accompanied by opsoclonus (AMS) as the two most frequent COVID-19 sequelae, with chorea, tremor and dystonia being very rare. The pathogenesis seems to be variable, but in the majority of AMS cases it was autoimmunological, with good response and recovery after corticosteroids or intravenous immunoglobulins infusions. Vaccination may be complicated by hyperkinetic movement disorders (e.g. tremor, dystonia), but this is very rare. Patients with Deep Brain Simulation depletion should not be postponed due to lockdowns as this may result in fatal outcomes.
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