Negative myoclonus associated with tramadol use

Abstract

Negative myoclonus (NM) is a brief involuntary jerky movement caused by a sudden lapse of tonic muscle contraction in the affected body segments. NM may appear not only in normal individuals physiologically during fear or sleep transition but also in patients with metabolic encephalopathy as flapping tremor (asterixis) [1-3]. Anticonvulsants, such as gabapentin and pregabalin, may also induce NM [4]. Tramadol, a synthetic codeine, is an analgesic used to treat various types of pain and is known to provoke generalized tonic-clonic seizure or myoclonus [5-8]. However, based on the Korean literature, studies assessing the presence of NM due to tramadol use have not been conducted yet. We hereby report a case of NM caused by the therapeutic dose of tramadol. Case This study was approved by the Institutional Review Board of the Negative myoclonus (NM) is a shock-like jerky involuntary movement caused by a sudden, brief interruption of tonic muscle contraction. NM is observed in patients diagnosed with epilepsy, metabolic encephalopathy, and drug toxicity and in patients with brain lesions. A 55-year-old man presented with NM in both his arms and neck. He has taken medications containing tramadol at a dose of 80-140 mg/day for 5 days due to common cold. He had no history of seizures. Acute lesions were not observed during magnetic resonance imaging, and abnormal findings in his laboratory tests were not noted. His NM resolved completely after the discontinuation of tramadol and the oral administration of clonazepam. Our case report suggests that tramadol can cause NM in patients without seizure history or metabolic disorders, even within its therapeutic dose.

Tramadol Induced Jerks

“…The maximum recommended daily dosing is 400mg per day. Although known for commonly causing side effects such as respiratory depression, serotonin syndrome, seizures [ 3 , 6 ], syncope, prolonged QT, and dependency, it is not widely popular that the synthetic opioid can cause myoclonus [ 4 ]. In one study it was reported that 12% of all drug-induced myoclonus was caused by opioids, and 25% of these were due to tramadol [ 7 ].…”

“…Tramadol is a synthetic opioid, known to cause side effects such as respiratory depression, serotonin syndrome, seizures [ 3 ], syncope, prolonged QT (interval in EKG), and dependency. It is not widely popular that this medicine can induce myoclonus [ 4 ] and in rare cases Parkinson's like symptoms [ 5 ].…”