Gluteal Myokymia, a Proximal Counterpart of Painless Legs, Moving Toes (P04.039)

Abstract

Objective: The objective of this abstract is to present a unique patient with involuntary movements of gluteus maximus muscles in whom onset, evolution of symproms and electromyographic pattern resembled that of painful legs, moveing toes except it involved the proximal muscles. Background Involuntary ,myokymic movememnts has been described in foot and hand muscles as painful (or painless ) legs moving toes (PLMT) and painful(or painless) moving hands. These myokymic movemnts often arise from injury to peripheral nerves or nerve roots. To our knowledge a myokymic movement with unilatral onset evolving into bilateral movements has not be described before in the gutei muscles. Design/Methods: A 52 year-old female was evaluated for poor balance associated with movements of buttocks for the past 10 years. The movements started in the left side and then became bilateral. She had a history of extensive pelvic endometriosis which required surgical intervention. On examination, involuntary movements were noted in both buttocks involving the gluteus maximus muscles. Results: Electromyography demonstrated ongoing myokymic movements with characteristic periodic pattern . ry sounds. The discharges occured synchronously in both glutei. Magnetic resonance imaging (MRI) of lumbosacral area demonstrated narrowing of L5-S1 foramen with commpression of corresponding nerve root. Cervical and thoracic MRI disclosed no spinal cord pathology. Treatment with onabotulinum toxin -A reduced the movemnts significantly. Conclusions: A syndrome similar to painful legs, moving toes exists in proximal leg muscles. In the case of our patient ,the movements started in one gluteus maximus and then spread to the other side(videotape) suggesting developemt of a spinal loop (as PLMT). Like PLMT, EMG of glutei muscles showed myokymia (videotape). We suggest that root compression on the side of firsr affected gluteus muscle caused the myokymic movements of that muscle. Disclosure: Dr. Sorokin has nothing to disclose. Dr. DiCapua has nothing to disclose. Dr. Mittal has nothing to disclose. Dr. Jabbari has nothing to disclose.