P155 – 3082: Generalized fasciculations after infection with human herpes virus type 7

Abstract

Objective Fasciculation occurs regularly among children. Neurologically, it represents the spontaneous firing of a motor unit (portion of muscle innervated by one branch of a nerve). These are very fast twitches that may disturb but don't involve enough muscle to actually jerk a limb. Some patients have generalized and intense fasciculation without other impairments or symptoms. Clinicians use many terms including undulating myokymia and Isaacs' syndrome to describe the motor manifestation of generalized peripheral nerve hyperexcitability (PNH). Several studies correlate PNH with immune-mediated processes, particularly anti-VGKC, but overall many cases still remain without a defined etiology. With this work we would like to present a case of generalized fasciculations after a Central Nerve System infection in a patient with previous history of serious imunoalergologic pathology. Methods Review of case and auxiliary diagnostic tests. Results A 15 year-old boy with previous history of asthma difficult to control, was admitted with sudden unset of generalized fasciculation's in all 4 members, improved after an initial pulse of methylprednisolone (50 mg) and oxcarbamazepin (600 mg). The EMG revealed generalized complex fasciculation's, suggesting motor neuron pathology. The MRI (brain and spinal) was normal. Blood test were normal (CK, anti-VGKC, anti-LGI1, anti-CASPR2, anti-GAD, anti-finfisin) except elevation of IgE 6000. The CSF was positive for Human Herpes Virus type 7 (HH7) DNA (PCR). After a few weeks of continued treatment the improvement was impressive, stopping the rest fasciculation, and just maintaining self-limiting episodes of twitching in all four limbs after very long walks and with very short duration. Recent EMG is normal. Conclusion This case describes an onset of generalized fasciculation during an infection with HH7 in a patient with hard imunoalergologic pathology. Herein is assumed that the infection may have triggered an immune response that resulted in such a syndrome.