Introduction Propriospinal Myoclonus (PSM) was first described as flexion or extension nonrhythmic repetitive myoclonic jerks arising in axial muscles, spreading to more caudal and rostral segments. Electrophysiologic features include a fixed pattern of muscle activation, slow conduction velocity, EMG burst duration of less than 1.000 ms, synchronous activation of agonist and antagonist muscles, and no facial involvement. The purpose of our study is to describe the usefulness of surface polymyography (sPMG) and jerk-lock techniques in the diagnosis of PSM. Methods Two patients with an involuntary periodic movement disorder were examined. Case 1: Patient underwent sPMG, back averaging and SSEPs testing. For jerk lock averaging, EMG with parallel EEG was registered from tibialis anterior (TA) muscle. SPMG activity was recorded with electrodes placed on paraspinalis dorsalis (PD) and lumbaris (PL), rectus femoris (RF), TA, and gastrocnemius (GM) muscles. The activity was scored for order of muscle recruitment, consistency of activation of the first muscle, consistency of pattern of spread of muscles involved, burst duration, and synchronous co-contraction muscle activation. Case 2: Back averaging, sPMG and SSEPs recordings were performed. For back averaging, sPMG was recorded from masseter, deltoideus, rectus abdominis (RA), PD, PL, RF and TA muscles. Triggers were set at burst onset of the initial muscle. SPMG recording muscles and study parameters were alike to the previous case, except that rectus abdominis rostral (RARA) and caudal aspect (RACA) muscles were added. Results Case 1: A 55-years old male presented with persistent jerks and involuntary lower limbs twitching. Awake and daytime sleep EEG did not show time-locked cortical correlate activity. SSEPs recordings were normal. During sPMG, burst activity started at PL muscle spreading upward to PD muscles and downward to right RF, TA and GM muscles. EMG burst occurred irregularly every 20–60 s, with duration of 100–800 ms. Case 2: A 60-years old male presented with excessive daytime sleepiness due to an acute onset of sudden abdominal jerks at the sleep- wake transition time. All jerks occurred at the transition from wake to sleep, and there were not Bereitschaftspotential preceding spontaneous activity. Burst started in RACA with rostro-caudal propagation. SPMG confirmed activation of the first muscle and consistency of pattern of spread. Jerks occurred irregularly every 20–60 s, with 100–800 ms duration. Co-contraction was evident. The latency of jerks recorded from RACA to RARA and from PD to TA was 55 ms and 95 ms, allowing calculation of spinal conduction velocity, found to be 9.1 ms−1 and 8.6 ms−1. SSEPs recordings were normal. Conclusion PMS is a rare movement disorder that arises from a spinal generator, with rostro-caudal propagation, which shows a typical electrophysiological pattern. We praise the using of sPMG to assess recruitment variability, combined with back averaging recordings to help to establish the diagnosis.
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