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Spinal myoclonus, involuntary muscle movements, was effectively treated with continuous intrathecal morphine infusion in two patients with myelopathy. This method provided significant relief, demonstrating a therapeutic benefit of opioids in specific spinal cord conditions.

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Area of Science:

  • Neurology
  • Spinal Cord Medicine
  • Pain Management

Background:

  • Spinal myoclonus involves involuntary muscle contractions originating in the spinal cord.
  • Opioid-induced myoclonus is a known phenomenon, but the pathophysiology remains unclear.
  • Spinal myoclonus can be secondary to conditions like myelopathy.

Purpose of the Study:

  • To investigate the efficacy of continuous intrathecal morphine infusion for treating spinal myoclonus secondary to myelopathy.
  • To explore the potential therapeutic role of opioids in spinal myoclonus, contrasting with opioid-induced myoclonus.

Main Methods:

  • Case report of two patients with spinal segmental myoclonus due to ischemic and radiation myelopathy.
  • Administration of continuous intrathecal morphine infusion for pain management and myoclonus control.
  • Observation of myoclonus recurrence upon cessation of morphine pump.

Main Results:

  • Conventional medications were ineffective for the patients' persistent leg myoclonus.
  • Continuous intrathecal morphine infusion completely resolved spinal myoclonus in both patients.
  • Myoclonus returned when the morphine infusion was stopped, confirming the opioid's therapeutic effect.

Conclusions:

  • Continuous intrathecal morphine infusion can be an effective treatment for spinal myoclonus secondary to myelopathy.
  • Opioids may exert a beneficial effect on spinal myoclonus, potentially through synaptic reorganization following spinal cord injury.
  • This contrasts with the adverse effect of opioid-induced myoclonus, suggesting a complex role for opioids in spinal cord disorders.