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1Department of Neurology, Mazumdar Shaw Medical Center, Narayana Hrudayalaya Hospital, Bangalore, India
2Department of Pulmonology, Mazumdar Shaw Medical Center, Narayana Hrudayalaya Hospital, Bangalore, India
Copyright © 2021 The Korean Movement Disorder Society
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Ethics Statement
Informed consent was obtained from patient for using his video (without masking) for publication purpose.
Conflicts of Interest
The authors have no financial conflicts of interest.
Author Contributions
Conceptualization: Kuldeep Shetty, Atul Manchakrao Jadhav, Ranjith Jayanthakumar. Data curation: all authors. Formal analysis: all authors. Funding acquisition: Kuldeep Shetty, Atul Manchakrao Jadhav, Ranjith Jayanthakumar, Gopal Krishna Dash, Radhika Manohar, Vivek Jacob Philip, Vikram Huded. Investigation: all authors. Methodology: all authors. Project administration: Kuldeep Shetty, Atul Manchakrao Jadhav, Ranjith Jayanthakumar. Resources: all authors. Software: Kuldeep Shetty, Atul Manchakrao Jadhav, Ranjith Jayanthakumar. Supervision: Kuldeep Shetty, Atul Manchakrao Jadhav, Ranjith Jayanthakumar. Validation: all authors. Visualization: all authors. Writing—original draft: all authors. Writing—review & editing: all authors.
Study | Cases (age in years, sex) | Lung involvement | Latency to onset of neurological symptoms from onset of systemic symptoms related to COVID-19 | Neurological features | Treatment and response |
---|---|---|---|---|---|
Rábano-Suárez et al. [4] | Case 1: 63, M | Case 1: Bilateral pneumonia, mechanically ventilated | Case 1: 9 days | Case 1: anosmia; myoclonic storm, more involving upper half of body; auditory and tactile stimulus sensitive; somnolence | Case 1: LEV, CLN, IVMP 1g/day for 5 days. PLEX × 5 cycles. Patient had sustained improvement only after PLEX. |
Case 2: 88, F | Case 2: Bilateral pneumonia | Case 2: 3 weeks | Case 2: anosmia, mild myoclonus, mild hypersomnia | Case 2: resolved with IVMP 250 mg/day for 3 days | |
Case 3: 76, M | Case 3: Bilateral pneumonia | Case 3: 11 days | Case 3: anosmia, mild myoclonus | Case 3: LEV, CLN, IVMP 250 mg/day for 3 days. Patient had delayed improvement after 2 weeks. | |
CSF: done for case 1 and 3, normal | |||||
Muccioli et al. [5] | 58, M | Respiratory distress, mechanically ventilated | 3 weeks | Brief agitation for 2 days-self resolved followed by multifocal myoclonus: action and tactile stimulus sensitive; diffuse, but more prominent in right proximal lower limb - causing marked disablility to stand | Symptoms resolved completely with symptomatic treatment with CLN and LEV in 5 days. |
HCQ, tocilizumab remdesivir given | |||||
Khoo et al. [6] | 65, F | Bilateral lung infiltrates seen | 7 days | Patient had baseline Alzheimer’s disease | IVMP 1 g /day for 3 days followed by oral steroid taper with prednisolone |
Unilateral onset of myoclonus generalised within 2 days, stimulus sensitive, with hyperkplexia to tactile, visual and auditory stimulus | Patient had significant improvement in cognition and myoclonus. Cognition improved to baseline. Myoclonus had not completely resolved at discharge (follow up till day 10 from start of steroids) | ||||
Noted cognitive decline: language difficulties, visual hallucination | |||||
This study | 41, M | Predominant right lower lung infiltrates | 10 days | Generalised severe myoclonus predominantly proximal, involving limbs and trunk, present at rest and on action, auditory and tactile stimulus sensitivity present, truncal ataxia noted | Noted moderate benefit with LEV and CLN |
Mild frontal dysfunction noted on detailed neuropsychology evaluation | IVMP 1 g/day given for 5 days -continued to improve |