Abstracts

Rationale: Myoclonus is a movement disorder that may occur with dysfunction in cortical, brainstem or spinal motor system. The term refers to sudden, involuntary jerking of a muscle or group of muscles. It may occur alone, but most often it is part of a group of symptoms associated with a wide variety of nervous system disorders. Some type of seizures and myoclonic movement disorders share similar neuronal mechanisms. Methods: We describe the case of a 78 years old man who came to our emergency department for an ictal phenomenon characterized by focal myoclonus involving his left arm, first intermittent and later continuous. It was spontaneous but was worsened by voluntary movement. The neurological examination showed only a mild segmental ataxia (both left arm and leg). Biochemistry and CT scan were negative. EEG with EMG surface registration in deltoid and triceps muscles didn’t show any epileptic discharge. Cerebral MRI showed lacunar acute vascular infarctions both in the mesencephalon and globus pallidum and multiple subcortical and periventricular chronic lacunes. Cervical MRI was normal. Results: Clonazepam given as a first choice drug, up to the dose of 6 mg/day, was ineffective. On the third day we switched to Levetiracetam at the dose of 500 mg rapidly titrated to 500 mg + 1000 mg. Two days after the beginning of Levetiracetam myoclonus decreased and three days later completely disappearedConclusions: In this case of nonepileptic myoclonus, LEV has been shown to be effective, as described in other preliminary studies.