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Letter to the editor Comment on “Chorea as a Presentation of SARS-CoV-2 Encephalitis: A Clinical Case Report”
Ruth H. Walker1,2orcid
Journal of Movement Disorders 2021;15(1):93-93.
DOI: https://doi.org/10.14802/jmd.21068
Published online: December 7, 2021
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1James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA

2Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

Corresponding author: Ruth H. Walker, MB, ChB, PhD James J. Peters Veterans Affairs Medical Center, 130 W Kingsbridge Rd, Bronx, NY 10468, USA / Tel: +01-718-584-9000-x5915 / Fax: +01-718-741-4708 / E-mail: ruth.walker@mssm.edu
• Received: May 19, 2021   • Revised: August 12, 2021   • Accepted: September 14, 2021

Copyright © 2022 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.

See the article "Chorea as a Presentation of SARS-CoV-2 Encephalitis: A Clinical Case Report" on page 245.
Dear Editor,
I was very interested to read the article by Hassan et al. [1] reporting chorea as a complication of COVID-19, as this movement disorder has not been previously correlated with this condition, to the best of my knowledge. However, I was disappointed to see that the video illustrated what appeared to be multifocal myoclonus. Myoclonus has been quite widely documented as one of the major movement disorder manifestations of cerebral involvement of SARS-CoV-2 infection [2]. This phenomenon may be related not only to hypoxia but also to generalized metabolic factors.
There can be some overlap in the appearance of these two hyperkinetic, irregular movement disorders, and electrophysiological testing is occasionally required to distinguish the two. However, I would argue that the rapid, jerky movements seen in the video strongly suggest myoclonus. I could not tell from the report, but it appeared that the movements were increased with volitional movement, which is characteristic of myoclonus, rather than chorea. The correct identification of the movement disorder is important, as it has implications for pharmacotherapeutic management; in the case of myoclonus, levetiracetam or benzodiazepines [2] are prescribed rather than the dopamine D2-receptor-blocking agents used in this case.
The underlying mechanism(s) for the generation of myoclonus in patients with SARS-CoV-2 infection are likely to be multifactorial and related to the underlying infectious process [3-5]; thus, resolution of the movement disorder is likely to parallel general medical recovery.

Ethical Standard

Not applicable.

Conflicts of Interest

The author has no financial conflicts of interest.

Funding Statement

None.

  • 1. Hassan M, Syed F, Ali L, Rajput HM, Faisal F, Shahzad W, et al. Chorea as a presentation of SARS-CoV-2 encephalitis: a clinical case report. J Mov Disord 2021;14:245–247.ArticlePubMedPMC
  • 2. Clark JR, Liotta EM, Reish NJ, Shlobin NA, Hoffman SC, Orban ZS, et al. Abnormal movements in hospitalized COVID-19 patients: a case series. J Neurol Sci 2021;423:117377.ArticlePubMedPMC
  • 3. Brandão PRP, Grippe TC, Pereira DA, Munhoz RP, Cardoso F. New-onset movement disorders associated with COVID-19. Tremor Other Hyperkinet Mov (N Y) 2021;11:26.ArticlePubMedPMC
  • 4. Ghosh R, Biswas U, Roy D, Pandit A, Lahiri D, Ray BK, et al. De novo movement disorders and COVID-19: exploring the interface. Mov Disord Clin Pract 2021;8:669–680.ArticlePMC
  • 5. Nirenberg MJ. New-onset movement disorders in COVID-19: much ado about nothing? Tremor Other Hyperkinet Mov (N Y) 2021;11:31.ArticlePubMedPMC

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    • Re: Comments on “Chorea as a Presentation of SARS-CoV-2 Encephalitis: A Clinical Case Report”
      Muhammad Hassan, Naveed Ullah Khan, Mazhar Badshah
      Journal of Movement Disorders.2022; 15(1): 94.     CrossRef

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