Not Everything That Shakes Is a Seizure: A Case Report

Area of Science:

• Anesthesiology
• Neurology

Background:

• Distinguishing nonepileptic myoclonus from epileptic seizures during anesthesia emergence is clinically challenging.
• Patient's myoclonus was misdiagnosed as refractory seizures, leading to inappropriate treatment with benzodiazepines and anesthetics.
• Altered consciousness post-anesthesia can obscure the clinical presentation of myoclonus, making differentiation difficult.

Purpose of the Study:

• To present a case of nonepileptic myoclonus mimicking refractory seizures in a patient emerging from general anesthesia.
• To illustrate the diagnostic challenges and therapeutic strategies for perioperative myoclonus.

Main Methods:

• Case report detailing a patient's presentation over six surgical procedures.
• Clinical observation and pharmacological intervention with levetiracetam.

Main Results:

• Levetiracetam, a first-line antiepileptic drug, effectively suppressed the patient's nonepileptic myoclonus.
• Accurate diagnosis and targeted treatment resolved the patient's symptoms, avoiding unnecessary sedation.

Conclusions:

• Perioperative myoclonus can be misdiagnosed as seizures, necessitating careful clinical evaluation.
• Levetiracetam demonstrates efficacy in managing nonepileptic myoclonus in the perioperative setting.
• Early identification and appropriate treatment are crucial for managing nonepileptic myoclonus during anesthesia recovery.