Uraemic myoclonus: an example of reticular reflex myoclonus?

Chadwick, D.; French, AnthonyJ.

doi:10.1136/jnnp.42.1.52

Cited by 48 publications

(14 citation statements)

References 7 publications

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“…If symptomatic treatment is warranted, clonazepam is reported to be effective. If a dramatic response is needed, clonazepam may be given intravenously with appropriate precautions taken to monitor and support vital signs if needed [16]. 5-Hydroxytryptophan was initially reported as helpful, but is now used rarely, if at all [61].…”

Section: Reticular Reflex Myoclonusmentioning

confidence: 99%

“…This designation does not include segmental myoclonus generation as the pathophysiology and characteristics of segmental myoclonus are distinct. Some examples of subcortical-nonsegmental myoclonus with their putative source locations in parentheses are: myoclonusdystonia syndrome (basal ganglia), opsoclonus-myoclonus syndrome (brainstem-cerebellar circuits), reticular reflex myoclonus (brainstem reticular formation), and propriospinal myoclonus (spinal cord) [14][15][16].…”

Section: Subcortical-nonsegmental Myoclonusmentioning

confidence: 99%

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Treatment of Myoclonus

Caviness

2014

Neurotherapeutics

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Myoclonus creates significant disability for patients. This symptom or sign can have many different etiologies, presentations, and pathophysiological mechanisms. A thorough evaluation for the myoclonus etiology is critical for developing a treatment strategy. The best etiological classification scheme is a modified version from that proposed by Marsden et al. in 1982. Clinical neurophysiology, as assessed by electromyography and electroencephalography, can be used to classify the pathophysiology of the myoclonus using a neurophysiology classification scheme. If the etiology of the myoclonus cannot be reversed or treated, then symptomatic treatment of the myoclonus itself may be warranted. Unfortunately, there are few controlled studies for myoclonus treatments. The treatment strategy for the myoclonus is best derived from the neurophysiology classification scheme categories: 1) cortical, 2) cortical-subcortical, 3) subcorticalnonsegmental, 4) segmental, and 5) peripheral. A cortical physiology classification is most common. Levetiracetam is suggested as first-line treatment for cortical myoclonus, but valproic acid and clonazepam are commonly used. Corticalsubcortical myoclonus is the physiology demonstrated by myoclonic seizures, such as in primary epileptic myoclonus (e.g., juvenile myoclonic epilepsy). Valproic acid has demonstrated efficacy in such epileptic syndromes with other medications providing an adjunctive role. Clonazepam is used for subcortical-nonsegmental myoclonus, but other treatments, depending on the syndrome, have been used for this physiological type of myoclonus. Segmental myoclonus is difficult to treat, but clonazepam and botulinum toxin are used. Botulinum toxin is used for focal examples of peripheral myoclonus. Myoclonus treatment is commonly not effective and/or limited by side effects.

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Section: Reticular Reflex Myoclonusmentioning

confidence: 99%

Section: Subcortical-nonsegmental Myoclonusmentioning

confidence: 99%

Treatment of Myoclonus

Caviness

2014

Neurotherapeutics

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“…Brainstem reticular reflex myoclonus has been reported most frequently in patients with generalised cerebral insults (hypoxia2, 6 and renal failure3) and only occasionally in patients with localised disease (cervical trauma8). It is known to coexist with cortical myoclonus 9.…”

Section: Discussionmentioning

confidence: 99%

“…The sudden, generalised, shock‐like, involuntary movements that characterise reticular reflex myoclonus are said to originate in the lower brainstem 1. It was described initially in the setting of chronic post‐hypoxic myoclonus,2 and subsequently in renal failure,3 non‐dopa‐responsive parkinsonism,4 Lyme disease,5 and procarbazine therapy for Hodgkin disease 5. These generalised cerebral conditions rarely cause discrete brainstem pathology that can be implicated clearly in the development of this movement disorder.…”

mentioning

confidence: 99%

Gaze‐evoked brainstem myoclonus

Williams

2003

Movement Disorders

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“…Patients with renal failure exhibit a variety of sensory-motor disorders, myoclonus [477] and restless legs syndrome [73,395,501,504]. Chadwick and French [59] reported that uremic myoclonus closely resembles posthypoxic myoclonus. They suggested that uremic myoclonus may be caused by the dysfunction of the NGC/NMC.…”

Section: Myoclonus (Including Restless Legs Syndrome and Periodic Legmentioning

confidence: 98%

Sensory-Motor Integration in the Medial Medulla

Lai¹,

Siegel²

2005

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The rostromedial medulla, including the nucleus gigantocellularis (NGC) and magnocellularis (NMC), plays a role as a relay nucleus for both the sensory and motor systems. The NGC/NMC is important in the modulation of somatic and visceral activities. Electrophysiological and pharmacological studies have shown that the NGC/NMC is involved in nociception, locomotion, regulation of basal muscle tone, sleep, as well as cardiovascular and pulmonary activities. Pharmacological and electrical stimulation of the NGC/NMC can produce opposite effects on physiological functions: analgesia or hyperalgesia, and suppression or facilitation of motor activity, depending on the subgroups of neurons activated and the states of the sleep-wake cycle at the time of stimulation. Sensory inputs including noxious and innocuous stimuli converge on the NGC/NMC. The NGC/NMC also plays a role as a relay nucleus, which sends sensory information to the higher centers. The NGC/NMC receives projections from the supra-bulbar motor facilitatory and inhibitory areas, and plays an important role in the regulation of motor activity. Pharmacologically, neurons in the NGC/NMC contribute to opioid, glutamate, GABA, acetylcholine, dopamine, substance P, neurotensin, hypocretin (orexin), and cannabinoid mediated sensory and motor activities, as well as cardiovascular and pulmonary functions. In this review, we will discuss the neuronal morphology, physiological functions and pharmacological characterization of the rostromedial medulla. We will consider the evidence that dysfunction of the NGC/NMC is a factor in a number of neurological diseases, including Parkinson's disease, restless legs syndrome, periodic leg movement, REM sleep behavior disorder, amyotrophic lateral sclerosis and narcolepsy. INTRODUNTIONThe medullary reticular formation is traditionally segregated into the medial somatic-and lateral visceralrelated areas. However, somatic and autonomic activities are well coordinated. For example, cardiovascular-respiratory changes are correlated with somatic sensory-motor activity during exercise. Coordination of somatic and autonomic activity can result from interconnections between somatic and autonomic control structures, as well as interactions within nuclei, which are involved in both somatic and autonomic activities. The rostromedial medulla (RMM) is one of the areas of the central nervous system (CNS) that is involved in both somatic and autonomic regulation. However, the RMM has traditionally been considered as a somatic nociceptive and a motor control area. The autonomic role of the RMM has received little attention, although Bach [22] demonstrated that the activation of RMM causes changes in cardiovascular and respiratory activity, as well as the facilitation and inhibition of somatic motor activity in 1952. Therefore, we will discuss the functional aspects of RMM in the modulation of both somatic and autonomic systems in this review. Section 1 will focus on the morphology of the RMM, and the anatomical link between RMM and the other areas...

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Uraemic myoclonus: an example of reticular reflex myoclonus?

Cited by 48 publications

References 7 publications

Treatment of Myoclonus

Treatment of Myoclonus

Gaze‐evoked brainstem myoclonus

Sensory-Motor Integration in the Medial Medulla

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