It can be start of myoclonus - myoclonic jerks / JME.

Regards

DB

Dear Dusan,

I wanted to say if believe in C3-C4 vertebra level of the neck as generator of kind of spinal myoclonus not rolandic central sulci positions..

Thank you for the valuable answer.

It is is posible then..to start JME at 81 year old age and after 16 hours of crisis maintaining a perfect allertness? 

My best whishes,

I like Ljubljana and Slovenia,

Ovidiu

First, did she was exposed to brain anoxia? let  me know the result of imaging studies.

Regards,

Dear Ashraf,

She didn't heart fealure or cerebral anoxia.. She was admitted with perfect  consciousness! And still have it. I will  check images on Monday. Thank you, Ovi

Better to do cervical MRI not CT

Regards,

It is important to look for other neurological signs, particularly for dementia, cerebellar features, eye movement abnormalities and any associated signs of systemic disease.

JME should be suspected at any age

and demonstrates the importance of obtaining a precise history

and performing an EEG with photic stimulation in

older adults with myoclonic seizures, GTCS or absence-like

events. Although such cases are probably very rare.

JME should be suspected at any age

and demonstrates the importance of obtaining a precise history

and performing an EEG with photic stimulation in

older adults with myoclonic seizures, GTCS or absence-like

events. Although such cases are probably very rare.

Photic stimulation was negative.. Thank you

Are you able to attach couple of EEG pages to visualise what you describing?

The lady has C6-C7 protrusion in CT.  No intracerebral acute processes

With LEV was better.. Also CZP..but now disnea low O2sat TEP possible differential diagnosis..complications as infección ulcera..Strong ATB ..

Anyway..the generalized polyspikes for more than 16h with no consciousness impairment is strange clinic situation for JME. My opininon..

Is there somebody thinking in subcortical/espinal generator?

Best,Ovi

Zaitoon please look the picture

From our experience and books JME occurs in adolescence. The history of continuous myoclonic  jerks  for 16 hr is not typical of JME.  The EEG sample is not clearly of that seen in JME.  It shows poly spikes very short duration (not spike and wave). 

Thank you Zaitoon, I corrected the announcement of the question... I wanted to ask last week if, do you believe that this condition I explained to you, could be interpreted as Myoclonus of subcortical origin *spinal C3/C4 cervical level*. Not rolandic as was understood by ones of us. Not epileptic (cortical generator). Of course the good way would be to analyse a giant SEP of tibial nerve.. or muscle sequence *EMG channels* set in proximal and distal limbs muscles, craneal nerve innervated muscles *brainstem*  during jerk, to see generation pattern. I have been on call yesterday night with epileptologist..they doubt of subcortical origin. Thank you to all of you!

Interesting we had a patient with very similar EEG and myoclonus, but this was more "deliberate and the "discharges" were very similar and to rapid to be cortical.  It helps to record surface EMG lead as you mentioned, simultaneously. 

These disharges are followed by slow potential & can not be disregrded as non epileptiform. 

To me the clinical picture rules out any form of myoclonic epilepsy. She has an acquired condition with diffuse, synchronous myoclonus with cortical EEG changes. I suppose I'd put the various acute and subacute encephalitities up in the differential list, but you have minimized any clinical signs of cortical involvement. The information given really rules out spinal myoclonus, so I am left with mentioning some sort of subcortical process - bleed? encephalitis or vasculitis? autoimmune disorder?

Was she on any medication previously? Or concomitantly? May be a toxic issue, e.g. combination of Tramadolol and Pregabaline for the pain following fracture may produce similar myoclonus with preserved reactivity.

I finished the residency period I am out from the Hospital now and could not verify after such a period of time. Probably she took these medicines for the fracture. Thank you very much Dirk!