Focal myoclonus following vestibular concussion: A diagnostic and treatment perspective.
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1
Carrick Institute, Neurology, United States
Objective: Successful treatment of an individual with post-concussive vertigo with paroxysmal focal myoclonus is described.
Clinical Features: The subject is a 27-year-old male former collegiate football player with a history of “10 or more” concussions. The most recent of which occurred from a slip-and-fall on ice in which he struck his head. Symptoms evolved rapidly into “severe migraines”, right arm pain, vertigo and focal myoclonus exacerbated in a head down position. On examination the following were observed: Up and left beating nystagmus with vision occluded, abnormalities in right and down gaze, horizontal and vertical pursuits and optokinetic responses (OKR), clonus in the right ankle, dysrhythmia in the upper and lower extremities and gait abnormalities with loss of associated movements.
Interventions and Outcomes: A case specific intensive multi-modal neuro-rehabilitation protocol was designed including a modified anterior canal repositioning maneuver, vestibular rehabilitation, neuromuscular reeducation, electrical stimulation and spinal manipulative thereapy over an initial 2 day period, with a 5 day follow-up after a period of two months. Post-treatment findings revealed an attenuation of his myoclonus, dizziness, arm pain and vertigo. No nystagmus was observed in occluded vision, gaze, pursuits and OKR were normal. Improvements were also seen in gait and rapid alternating movements in the upper and lower extremities among other findings.
Conclusions: Utilizing findings from a functional neurological exam, an individual protocol of intensive multi-modal neuro-rehabilitation was devised and implemented. Following the execution of the protocol he had an improvement in symptomatology and neurological findings. With further investigation, it may provide a therapeutic approach for other individuals with focal myoclonus.
Keywords:
Focal myoclonus,
Myoclonus,
vestibular,
Neuro rehabilitation,
Nystagmus,
concussion,
Vertigo,
Vestibular Rehabilitation,
Functional Neurology
Conference:
International Symposium on Clinical Neuroscience: TBI and Neurodegeneration, Orlando, Florida, United States, 10 Dec - 14 Dec, 2015.
Presentation Type:
Poster Presentation
Topic:
Case Reports for Poster Presentation
Citation:
Keiser
ND
(2015). Focal myoclonus following vestibular concussion: A diagnostic and treatment perspective..
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience: TBI and Neurodegeneration.
doi: 10.3389/conf.fneur.2015.58.00062
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Received:
30 Oct 2015;
Published Online:
02 Nov 2015.
*
Correspondence:
Dr. Nathan D Keiser, Carrick Institute, Neurology, Cape Canaveral, United States, dockeiser@gmail.com