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Background Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic in December 2019, neurological manifestations have been recognized as potential complications. Relatively rare movement disorders associated with COVID-19 are increasingly reported in case reports or case series. Here, we present a case and systematic review of myoclonus and cerebellar ataxia associated with COVID-19. Methods A systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline using the PubMed and Ovid MEDLINE databases, from November 1, 2019 to December 6, 2020. Results 51 cases of myoclonus or ataxia associated with COVID-19, including our case, were identified from 32 publications. The mean age was 59.6 years, ranging from 26 to 88 years, and 21.6% were female. Myoclonus was multifocal or generalized and had an acute onset, usually within 1 month of COVID-19 symptoms. Myoclonus occurred in isolation (46.7%), or with ataxia (40.0%) or cognitive changes (30.0%). Most cases improved within 2 months, and treatment included anti-epileptic medications or immunotherapy. Ataxia had an acute onset, usually within 1 month of COVID-19 symptoms, but could be an initial symptom. Concurrent neurological symptoms included cognitive changes (45.5%), myoclonus (36.4%), or a Miller Fisher syndrome variant (21.2%). Most cases improved within 2 months, either spontaneously or with immunotherapy. Conclusions This systematic review highlights myoclonus and ataxia as rare and treatable post-infectious or para-infectious, immune-mediated phenomena associated with COVID-19. The natural history is unknown and future investigation is needed to further characterize these movement disorders and COVID-19. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-021-10458-0.

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Freezing of gait (FOG) is a common symptom in Parkinson's disease (PD) and is a significant cause of falls, disability, and reduced quality of life. 1 Unfortunately, FOG is poorly understood pathophysiologically and remains difficult to treat. Beyond optimizing dopaminergic medications and considering surgical therapy, rehabilitation strategies are a mainstay of management. Behavioral strategies, such as using sensory cues or shifting weight to initiate gait, help reduce FOG. In addition, patients often develop their own compensatory strategies. 2 An 81-year-old right-hand-dominant male was assessed in clinic for PD. His symptoms began 7 years ago with the development of right-sided rest tremor in the hand, right-sided bradykinesia and rigidity, micrographia, and a slow, shuffling gait. Treatment with levodopa substantially improved his parkinsonism. 3 years after symptom onset, he developed FOG during gait initiation and turning. This was not dopamine responsive and progressed with increasing frequency and duration. Additional triggers included narrow spaces, doorways, navigating obstacles and crowds, and ambulating under time constraints. Physiotherapy strategies helped him avoid falls. However, to maintain safety during walking, he began using a 4-wheel walker at home and for short distances, which was not associated with improvement in FOG, and an electric scooter for long distances. His other motor symptoms continued to be well-managed with levodopa and non-motor symptoms were non-contributory.At 81 years of age, he created his own strategy to address FOG while performing upper extremity exercises with resistance bands. He decided to secure resistance bands (TheraBand, Akron, OH) under the soles of his feet individually or simultaneously and hold them at the level of the handles of his 4-wheel walker, such that the bands were mildly stretched superiorly and anteriorly (Video 1 and Video 2). He did not actively pull on the bands and passive elasticity helped facilitate gait initiation and maintenance. With the use of