Bilateral myoclonus of the trapezius muscles after distal lesion of an accessory nerve
Identifieur interne : 002065 ( Istex/Corpus ); précédent : 002064; suivant : 002066Bilateral myoclonus of the trapezius muscles after distal lesion of an accessory nerve
Auteurs : Franz X. Glocker ; Deuschl ; Benedikt Volk ; Joachim Hasse ; Carl H. LückingSource :
- Movement Disorders [ 0885-3185 ] ; 1996-09.
English descriptors
Abstract
Observations of rhythmic or semirhythmic myoclonus due to a peripheral nerve lesion are exceptional. We report on a patient with thorax trauma with multiple bilateral hematomas of the paravertebral musculature. Eight years later he developed rhythmic myoclonus of both trapezius muscles and thoracic pain. Infiltration of a paramedially located scar at the level of D5–6 with a local anesthetic agent led to an intermittent relief of the myoclonus as did anesthetic blockade of the left accessory nerve. Surgical excision of the scar, which contained multiple dystrophic axons on histological examination, cured the patient's symptoms as illustrated in a videotape. This indicates that peripheral afferents contributed to the myoclonus. Ephaptic transmission, ectopic excitation, or misdirected neuronal sprouting secondary to the trauma are possible peripheral mechanisms responsible for the movement disorder. Successful blockade of the left accessory nerve with bilateral relief of the symptoms suggests a secondary, more centrally located mechanism, e.g., in the brain stem, probably driven by an altered afferent input. It is concluded that rhythmic or semirhythmic and focal myoclonus need a careful workup to look for a peripheral cause because such a condition would be accessible for surgical treatment.
Url:
DOI: 10.1002/mds.870110514
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ISTEX:9D803678A52734C31C60684643094CC322EB1AAALe document en format XML
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We report on a patient with thorax trauma with multiple bilateral hematomas of the paravertebral musculature. Eight years later he developed rhythmic myoclonus of both trapezius muscles and thoracic pain. Infiltration of a paramedially located scar at the level of D5–6 with a local anesthetic agent led to an intermittent relief of the myoclonus as did anesthetic blockade of the left accessory nerve. Surgical excision of the scar, which contained multiple dystrophic axons on histological examination, cured the patient's symptoms as illustrated in a videotape. This indicates that peripheral afferents contributed to the myoclonus. Ephaptic transmission, ectopic excitation, or misdirected neuronal sprouting secondary to the trauma are possible peripheral mechanisms responsible for the movement disorder. Successful blockade of the left accessory nerve with bilateral relief of the symptoms suggests a secondary, more centrally located mechanism, e.g., in the brain stem, probably driven by an altered afferent input. It is concluded that rhythmic or semirhythmic and focal myoclonus need a careful workup to look for a peripheral cause because such a condition would be accessible for surgical treatment.</div></front></TEI><istex><corpusName>wiley</corpusName><author><json:item><name>Franz X. Glocker</name><affiliations><json:string>Departments of Neurology and Clinical Neurophysiology, University of Freiburg, Freiburg, Germany</json:string></affiliations></json:item><json:item><name>Dr. Deuschl</name><affiliations><json:string>Departments of Neurology and Clinical Neurophysiology, University of Freiburg, Freiburg, Germany</json:string></affiliations></json:item><json:item><name>Benedikt Volk</name><affiliations><json:string>Department of Neuropathology, University of Freiburg, Freiburg, Germany</json:string></affiliations></json:item><json:item><name>Joachim Hasse</name><affiliations><json:string>Department of Pulmonary Surgery, University of Freiburg, Freiburg, Germany</json:string></affiliations></json:item><json:item><name>Carl H. Lücking</name><affiliations><json:string>Departments of Neurology and Clinical Neurophysiology, University of Freiburg, Freiburg, Germany</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Spinal myoclonus</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Peripheral myoclonus</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Peripheral nerve lesion</value></json:item></subject><language><json:string>eng</json:string></language><abstract>Observations of rhythmic or semirhythmic myoclonus due to a peripheral nerve lesion are exceptional. We report on a patient with thorax trauma with multiple bilateral hematomas of the paravertebral musculature. Eight years later he developed rhythmic myoclonus of both trapezius muscles and thoracic pain. Infiltration of a paramedially located scar at the level of D5–6 with a local anesthetic agent led to an intermittent relief of the myoclonus as did anesthetic blockade of the left accessory nerve. Surgical excision of the scar, which contained multiple dystrophic axons on histological examination, cured the patient's symptoms as illustrated in a videotape. This indicates that peripheral afferents contributed to the myoclonus. Ephaptic transmission, ectopic excitation, or misdirected neuronal sprouting secondary to the trauma are possible peripheral mechanisms responsible for the movement disorder. Successful blockade of the left accessory nerve with bilateral relief of the symptoms suggests a secondary, more centrally located mechanism, e.g., in the brain stem, probably driven by an altered afferent input. 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Successful blockade of the left accessory nerve with bilateral relief of the symptoms suggests a secondary, more centrally located mechanism, e.g., in the brain stem, probably driven by an altered afferent input. 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Successful blockade of the left accessory nerve with bilateral relief of the symptoms suggests a secondary, more centrally located mechanism, e.g., in the brain stem, probably driven by an altered afferent input. 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We report on a patient with thorax trauma with multiple bilateral hematomas of the paravertebral musculature. Eight years later he developed rhythmic myoclonus of both trapezius muscles and thoracic pain. Infiltration of a paramedially located scar at the level of D5–6 with a local anesthetic agent led to an intermittent relief of the myoclonus as did anesthetic blockade of the left accessory nerve. Surgical excision of the scar, which contained multiple dystrophic axons on histological examination, cured the patient's symptoms as illustrated in a videotape. This indicates that peripheral afferents contributed to the myoclonus. Ephaptic transmission, ectopic excitation, or misdirected neuronal sprouting secondary to the trauma are possible peripheral mechanisms responsible for the movement disorder. Successful blockade of the left accessory nerve with bilateral relief of the symptoms suggests a secondary, more centrally located mechanism, e.g., in the brain stem, probably driven by an altered afferent input. It is concluded that rhythmic or semirhythmic and focal myoclonus need a careful workup to look for a peripheral cause because such a condition would be accessible for surgical treatment.</abstract><subject lang="en"><genre>Keywords</genre><topic>Spinal myoclonus</topic><topic>Peripheral myoclonus</topic><topic>Peripheral nerve lesion</topic></subject><relatedItem type="host"><titleInfo><title>Movement Disorders</title><subTitle>Official Journal of the Movement Disorder Society</subTitle></titleInfo><titleInfo type="abbreviated"><title>Mov. 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|texte= Bilateral myoclonus of the trapezius muscles after distal lesion of an accessory nerve
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