Blepharoclonus, pseudoasterixis, and restless feet

To report a syndrome in 30 patients characterized by headache, myoclonic tremors of the eyelids (blepharoclonus), action tremors of the hands on flexion-extension movements at the wrists simulating asterixis (pseudoasterixis) and habitual diurnal movements of the feet. Ten patients are described in detail.

Clinical history, neurologic examination, computed tomography of the head, magnetic resonance imaging of the brain, electroencephalogram, electromyogram, and nerve conduction velocities. Headaches were diagnosed according to the International Headache Society classification. A retrospective uncontrolled review of the cases collected by the author was completed.

Seven patients had migraine with aura and 8 without aura; 3 had both migraine and tension headache, 11 had tension headache, 2 had cluster headache, and 1 had idiopathic stabbing headache. None of the patients had tumoral lesions or vascular malformations of the brain. Eight of the subjects had history of somnambulism and 9 had family history of somnambulism. Restless legs syndrome was present in 8 patients in addition to restless feet. Some evidence of axonal peripheral neuropathy was present in 13 patients.

This report supports the notion that in certain cases, an association exists between headache, involuntary movement disorders, and peripheral neuropathy. Additional studies are needed to elucidate the pathogenesis of this syndrome.