COVID-19 presents with various neurological manifestations in about 37% of patients. A recent report from Spain described generalised myoclonus in 3 patients with COVID-19. Patients were in older age group and had usual symptoms of COVID-19 such as fever, cough, breathing difficulty and anosmia at admission. Myoclonus developed in the second week of illness, characterised by jerky movements involving face, neck and upper limbs. Anti-epileptic drugs such as valproate, levetiracetam and clonazepam were of no use in controlling these myoclonic jerks. Myoclonus responded to immunotherapy with methylprednisolone in 2 patients, and one patient required plasmapheresis. MRI brain and EEG were normal.
Conclusions
1. Myoclonus can occur in patients with COVID-19.
2. Underlying mechanism could be immune-mediated or direct virus spread, affecting brainstem and hypothalamus.
3. Anti-epileptic drugs do not work. Immunotherapy is useful.
(Source: Neurology, May 21, 2020)
