3-30-05 A case of segmental myoclonus in amputation stump: Evidence for spinal generator

Jumpy stump syndrome treated by targeted muscle reinnervation (TMR): a case report and review of the literature

“…Similarly, Devetag Chalaupka et al described a patient who developed involuntary jerks of the stump thirty days after an above-knee amputation. In this case, electrophysiologic findings showed that the limb movements were involuntary and myoclonic in nature and limited to the muscles innervated by L2-L4 spinal segments 13 …”

“…4,19 Benzodiazepines have also been used to treat jumpy stump with varying efficacy. 13,16,25 Devetag Chalaupka et al reported complete improvement of symptoms in an aboveknee amputee patient using 0.5 mg TID of clonazepam and 3 yr later, the patient stopped using clonazepam with no return of symptoms. 13 Another report found that benzodiazepines attenuated movements in a patient that developed uncontrollable "jumping" of all limbs after through-hip amputation.…”

“…13,16,25 Devetag Chalaupka et al reported complete improvement of symptoms in an aboveknee amputee patient using 0.5 mg TID of clonazepam and 3 yr later, the patient stopped using clonazepam with no return of symptoms. 13 Another report found that benzodiazepines attenuated movements in a patient that developed uncontrollable "jumping" of all limbs after through-hip amputation. 16 Initially, oral diazepam successfully controlled the patient's symptoms; however, uncontrollable limb movements returned after debridement and closure of the amputation skin flap.…”

“…In this case, electrophysiologic findings showed that the limb movements were involuntary and myoclonic in nature and limited to the muscles innervated by L2-L4 spinal segments. 13 Financial Disclosure: The authors report no conflicts of interest. This study was performed ethically as a case report/series, receiving consent from the patient to write on his case.…”

“…Although Hancock suspected neuromas may influence involuntary movement, "jumpy stump syndrome" was traditionally thought to be a form of spinal reflex myoclonus. 9,[11][12][13] Steiner et al later reported five cases of "jumping amputation stumps", suggesting the phenomenon represented an "alternating reflex segmental myoclonus" in which afferent pathways reduced inhibitory spinal intraneuronal influence over motor neurons. 11 Iacono et al later hypothesized that involuntary movements in two postamputation patients arose from neural generators intrinsic to the spinal cord.…”