SPINAL MYOCLONUS COMPLICATING SPASTICITY IN SPINAL-CORD INJURY - A CASE-STUDY

A case of spinal myoclonus that complicated spasticity management is p resented. A 37-year-old man with a C6 American Spinal Injury Associati on class B spinal cord injury was referred for treatment of spasticity . He had failed previous treatments with baclofen and dantrolene but w as partly relieved by diazepam, although with unacceptable side effect s. Further evaluation, including simultaneous electroencephalogram, vi deotaping, and electromyography of the quadriceps, anterior tibialis, posterior tibialis, and medial hamstring suggested myoclonic jerks of spinal origin that initiated episodes of unsustained clonus. During th e worst episodes, myoclonic jerks came once every 16 to 22 seconds and persisted for 4 to 5 hours. Each episode of clonus lasted approximate ly 4 to 6 seconds. Treatment with valproic acid greatly diminished the frequency of myoclonic jerks with minimal side effects. Functionally, the patient was much less fatigued and better able to maintain his fu ll time employment. (C) 1997 by the American Congress of Rehabilitatio n Medicine and the American Academy of Physical Medicine and Rehabilit ation.