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Myoclonus in Patients With Coronavirus Disease 2019: A Multicenter Case Series
Pria Anand1, Asma Zakaria2, Karima Benameur3
1Department of Neurology, Boston University Medical Center, Boston, MA.
Insights
Myoclonus, or sudden muscle jerks, can occur in patients with coronavirus disease 2019 (COVID-19), sometimes without hypoxia. This neurological symptom
Area of Science:
- Neurology
- Infectious Diseases
- Critical Care Medicine
Background:
- Myoclonus is a neurological symptom characterized by sudden, involuntary muscle jerks.
- The occurrence and significance of myoclonus in patients with coronavirus disease 2019 (COVID-19) are not well-established.
- Understanding the risk factors and outcomes associated with COVID-19-related myoclonus is crucial for patient management.
Purpose of the Study:
- To describe the risk factors and outcomes associated with myoclonus in patients diagnosed with COVID-19.
- To investigate potential contributing factors to myoclonus in the context of COVID-19 infection.
- To evaluate the clinical course and resolution of myoclonus in this patient population.
Main Methods:
- A multicenter case series was conducted.
- Data were collected from eight patients with clinical myoclonus and COVID-19 across three tertiary care hospitals.
- Clinical presentation, potential contributing factors, and patient outcomes were analyzed.
Main Results:
- Seven out of eight patients had potential contributing factors such as metabolic derangements, hypoxemia, or sedative medication exposure.
- One patient developed prolonged myoclonus with encephalopathy without clear systemic triggers.
- Outcomes varied: one death, five patients extubated cognitively intact; myoclonus resolved within 2 days in five cases, persisting longer in three.
Conclusions:
- Myoclonus can occur in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected patients, even without hypoxia.
- The presence of myoclonus in COVID-19 patients warrants further investigation in larger cohorts.
- Myoclonus may potentially serve as an indicator of disease severity, neurological involvement, or prognosis in COVID-19.
Objectives:
To describe the risk factors for and outcomes after myoclonus in a cohort of patients with coronavirus disease 2019.
Design:
Multicenter case series.
Setting:
Three tertiary care hospitals in Massachusetts, Georgia, and Virginia.
Patients:
Eight patients with clinical myoclonus in the setting of coronavirus disease 2019.
Interventions & Measurements And Main Results:
Outcomes in patients with myoclonus were variable, with one patient who died during the study period and five who were successfully extubated cognitively intact and without focal neurologic deficits. In five cases, the myoclonus completely resolved within 2 days of onset, while in three cases, it persisted for 10 days or longer. Seven patients experienced significant metabolic derangements, hypoxemia, or exposure to sedating medications that may have contributed to the development of myoclonus. One patient presented with encephalopathy and developed prolonged myoclonus in the absence of clear systemic provoking factors.
Conclusions:
Our findings suggest that myoclonus may be observed in severe acute respiratory syndrome coronavirus 2 infected patients, even in the absence of hypoxia. This association warrants further evaluation in larger cohorts to determine whether the presence of myoclonus may aid in the assessment of disease severity, neurologic involvement, or prognostication.
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