A Moving Residual Limb: Botulinum Toxin to the Rescue.

Marie-Michèle Briand,Geneviève Sirois,Min Cheol Chang,Xavier Rodrigue,Mathieu Boudier-Réveret

doi:10.1515/tnsci-2020-0006

Abstract

Movement disorders post-amputation are a rare complication and can manifest as the jumping stump phenomenon, a form of peripheral myoclonus. The pathophysiology remains unknown and there is currently no standardized treatment. We describe the case of a 57-year-old male with unremitting stump myoclonus, starting one month after transtibial amputation, in his residual limb without associated phantom or neurological pain. The consequence of the myoclonus was a reduction in prosthetic wearing time. Failure to respond to oral medication led us to attempt the use of botulinum neurotoxin Type A injections in the involved muscles of the residual limb. Injection trials, over a two-year period, resulted in an improvement of movement disorder, an increased prosthetic wearing time and a higher satisfaction level of the patient. Injection of botulinum toxin type A should be considered as an alternative treatment for stump myoclonus to improve prosthetic wearing time and comfort.

Highlights

Jumping stump is a rare post-amputation complication
Botulinum toxin, which prevents the release of the neurotransmitter acetylcholine at the axon ending of the neuromuscular junction, acts to denervate muscles and has been successfully used in other types of myoclonus [5, 6]
The patient clearly differentiated phantom pain from the pressure sensation, but atypical neurologic pain was not excluded for this sensation and neuromas were our main diagnostic hypothesis to explain the abnormal movement

Summary

Introduction

Jumping stump is a rare post-amputation complication. It has been described as a form of peripheral myoclonus which is characterized by sudden, brief and sometimesNo guideline or standardized treatment exist for jumping stump or peripheral myoclonus. Abstract: Movement disorders post-amputation are a rare complication and can manifest as the jumping stump phenomenon, a form of peripheral myoclonus. We describe the case of a 57-year-old male with unremitting stump myoclonus, starting one month after transtibial amputation, in his residual limb without associated phantom or neurological pain.

Results

Conclusion