Generalized myoclonus in COVID-19

Abstract

ObjectiveTo report 3 patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who developed generalized myoclonus.MethodsPatient data were obtained from medical records from the University Hospital “12 de Octubre,” Madrid, Spain.ResultsThree patients (2 men and 1 woman, aged 63–88 years) presented with mild hypersomnia and generalized myoclonus following the onset of the so-called inflammatory phase of coronavirus disease 2019 (COVID-19). All of them had presented previously with anosmia. Myoclonus was generalized with both positive and negative jerks, predominantly involving the facial, trapezius, sternocleidomastoid, and upper extremities muscles. These myoclonic jerks occurred spontaneously and were extremely sensitive to multisensory stimuli (auditive and tactile) or voluntary movements, with an exaggerated startle response. Other causes of myoclonus were ruled out, and none of the patients had undergone respiratory arrest or significant prolonged hypoxia. All of them improved, at least partially, with immunotherapy.ConclusionsOur 3 cases highlight the occurrence of myoclonus during the COVID-19 pandemic as a post- or para-infectious immune-mediated disorder. However, we cannot rule out that SARS-CoV-2 may spread transneuronally to first- and second-order structures connected with the olfactory bulb. Further investigation is required to clarify the full clinical spectrum of neurologic symptoms and optimal treatment.

Subcortical Myoclonus in Coronavirus Disease 2019: Comprehensive Evaluation of a Patient

“…Interestingly, cytokine-mediated neuroinflammation induced by SARS-CoV-2 has been implicated in steroid-responsive COVID-19-associated encephalopathy. 8 In addition to marked agitation in our patient, previous reports also had clinical/instrumental findings suggestive of encephalopathy, including dysexecutive syndrome, delirium, somnolence, EEG slowing, elevated inflammatory markers, variable responses to immunotherapies, and a benign clinical course, [1][2][3][4] further suggesting an immune-mediated/inflammatory pathogenesis.…”

“…In previously published reports, myoclonus has been described as spontaneous or action-induced, multifocal or generalized, with a nonspecific distribution. [1][2][3][4] In our patient, the prominent involvement of axial and proximal limb muscles, myoclonus stimulus sensitivity, the absence of cortical discharges at EEG jerk-locked back-averaging, and the long duration of myoclonic bursts are consistent with subcortical myoclonus, possibly secondary to brainstem involvement.…”

COVID-19 and possible links with Parkinson’s disease and parkinsonism: from bench to bedside

“…A significant number of those diagnosed with COVID-19 have reported a broad spectrum of neurological consequences [26][27][28][29][30][31][32] . Neurological symptoms include those associated with dysfunction of the central (fatigue, headache, confusion, stroke 33 , dizziness, syncope 34 , seizure, anorexia, and insomnia) [35][36][37][38] , peripheral (anosmia, ageusia, myoclonus 39 , neuropathic pain, and myalgias) 26,35,40 , combined central-peripheral (Guillain Barre syndrome 41 ) and enteric nervous systems (diarrhea 13 ). Some gastrointestinal manifestations, including diarrhea, may be related to the expression of the viral receptor ACE2 and a serine protease, transmembrane serine protease 2 (TMPRSS2), involved in S protein priming, in the small intestinal epithelia and colon 42 .…”

Autonomic dysfunction heralding acute motor axonal neuropathy in COVID-19

“…Physicians are seeing increasingly more patients with a spectrum of neurological manifestations associated with coronavirus disease 2019 (Ghosh et al 2020;Gutiérrez-Ortiz et al 2020;Rábano-Suárez et al 2020;Roy et al 2020). However, the pathogenesis of COVID-19-induced neurological manifestations is still in its infancy.…”

“…Discussion SARS-CoV-2 has potential for neurotropism (Li et al 2020;Rábano-Suárez et al 2020;Roy et al 2020). Study with animal models have demonstrated that SARS-CoV and MERS-CoV, possibly via olfactory nerves, can spread rapidly inside central nervous system, thalamus and brainstem in particular (Li et al 2020).…”