0826 A Case of Propriospinal Myoclonus in a patient with Multiple Sclerosis

Abstract

Abstract Introduction Described first in 1991, by Brown et al, Propriospinal Myoclonus is a rare movement disorder of rhythmic, typically flexor, jerking motions most pronounced when lying supine. Although most cases are thought to be idiopathic, identified causes have been infection, spinal lesions, and psychogenic. Report of Cases: A 38-year-old female with medical history of multiple sclerosis, anxiety and PCOS was referred for jerking body movements with sleep onset. Symptoms of nightly, full body jerking, beginning in her back, were described as “legs being pulled up towards the chest” and present only while lying supine in bed with symptom onset of 1 month. Difficulty initiating sleep and daytime sleepiness ensued as a result of these jerks. Work-up with in-lab polysomnogram failed to demonstrate obstructive sleep apnea (AHI 2.8/hr), however, did demonstrate periodic limb movements of sleep. MRI of the brain, cervical spine, and thoracic spine were negative for new or enhancing brain or spinal cord lesions. CBC, CMP, TSH and ceruloplasmin were ordered for a complete myoclonus evaluation and found to be within normal limits. She was started on Klonopin 0.5 mg at night. Three month follow-up revealed improvement of symptoms, with the frequency of her myoclonus decreased to 1-2 episodes per week with reported less intensity of each event. Conclusion While proper work-ups are always important, this case reminds us of the diligence required when certain conditions exist. Although our patient had a negative myoclonus work-up, and is thought to have idiopathic myoclonus, the presence of multiple sclerosis made the investigation increasingly relevant. Work-up should include an MRI to rule-out spinal cord lesions. Support (If Any) None