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Abstract

Objective

To report 3 patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who developed generalized myoclonus.

Methods

Patient data were obtained from medical records from the University Hospital “12 de Octubre,” Madrid, Spain.

Results

Three patients (2 men and 1 woman, aged 63–88 years) presented with mild hypersomnia and generalized myoclonus following the onset of the so-called inflammatory phase of coronavirus disease 2019 (COVID-19). All of them had presented previously with anosmia. Myoclonus was generalized with both positive and negative jerks, predominantly involving the facial, trapezius, sternocleidomastoid, and upper extremities muscles. These myoclonic jerks occurred spontaneously and were extremely sensitive to multisensory stimuli (auditive and tactile) or voluntary movements, with an exaggerated startle response. Other causes of myoclonus were ruled out, and none of the patients had undergone respiratory arrest or significant prolonged hypoxia. All of them improved, at least partially, with immunotherapy.

Conclusions

Our 3 cases highlight the occurrence of myoclonus during the COVID-19 pandemic as a post- or para-infectious immune-mediated disorder. However, we cannot rule out that SARS-CoV-2 may spread transneuronally to first- and second-order structures connected with the olfactory bulb. Further investigation is required to clarify the full clinical spectrum of neurologic symptoms and optimal treatment.

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Information & Authors

Information

Published In

Neurology®
Volume 95Number 6August 11, 2020
Pages: e767-e772
PubMed: 32439821

Publication History

Received: April 22, 2020
Accepted: May 12, 2020
Published online: May 21, 2020
Published in print: August 11, 2020

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Disclosure

The authors report no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.

Study Funding

This research was supported by FEDER funds.

Authors

Affiliations & Disclosures

Pablo Rábano-Suárez, MD*
From the Departments of Neurology (P.R.-S., L.B.-G., A.M.-G., J.P.-S., D.T.-A., D.S.-T., T.S.-F., J.G.d.l.A., J.B.-L.), Microbiology (M.D.F.-L.), Intensive Care Unit (J.G.-G.), and Internal Medicine (B.A.-G.), University Hospital “12 de Octubre”; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); and Department of Medicine (M.D.F.-L., J.B.-L.), Universidad Complutense, Madrid, Spain.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
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1.
NONE
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1.
NONE
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1.
NONE
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NONE
Laura Bermejo-Guerrero, MD*
From the Departments of Neurology (P.R.-S., L.B.-G., A.M.-G., J.P.-S., D.T.-A., D.S.-T., T.S.-F., J.G.d.l.A., J.B.-L.), Microbiology (M.D.F.-L.), Intensive Care Unit (J.G.-G.), and Internal Medicine (B.A.-G.), University Hospital “12 de Octubre”; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); and Department of Medicine (M.D.F.-L., J.B.-L.), Universidad Complutense, Madrid, Spain.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
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1.
NONE
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1.
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Antonio Méndez-Guerrero, MD* https://orcid.org/0000-0001-5792-9361
From the Departments of Neurology (P.R.-S., L.B.-G., A.M.-G., J.P.-S., D.T.-A., D.S.-T., T.S.-F., J.G.d.l.A., J.B.-L.), Microbiology (M.D.F.-L.), Intensive Care Unit (J.G.-G.), and Internal Medicine (B.A.-G.), University Hospital “12 de Octubre”; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); and Department of Medicine (M.D.F.-L., J.B.-L.), Universidad Complutense, Madrid, Spain.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
(1) Abbvie Pharmaceuticals, funding for travel to conference(2) Bial, funding for travel to conference
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
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1.
NONE
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1.
NONE
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1.
NONE
Legal Proceedings:
1.
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Javier Parra-Serrano, MD
From the Departments of Neurology (P.R.-S., L.B.-G., A.M.-G., J.P.-S., D.T.-A., D.S.-T., T.S.-F., J.G.d.l.A., J.B.-L.), Microbiology (M.D.F.-L.), Intensive Care Unit (J.G.-G.), and Internal Medicine (B.A.-G.), University Hospital “12 de Octubre”; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); and Department of Medicine (M.D.F.-L., J.B.-L.), Universidad Complutense, Madrid, Spain.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
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1.
NONE
Legal Proceedings:
1.
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Daniel Toledo-Alfocea, MD https://orcid.org/0000-0002-5624-638X
From the Departments of Neurology (P.R.-S., L.B.-G., A.M.-G., J.P.-S., D.T.-A., D.S.-T., T.S.-F., J.G.d.l.A., J.B.-L.), Microbiology (M.D.F.-L.), Intensive Care Unit (J.G.-G.), and Internal Medicine (B.A.-G.), University Hospital “12 de Octubre”; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); and Department of Medicine (M.D.F.-L., J.B.-L.), Universidad Complutense, Madrid, Spain.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Daniel Sánchez-Tejerina, MD
From the Departments of Neurology (P.R.-S., L.B.-G., A.M.-G., J.P.-S., D.T.-A., D.S.-T., T.S.-F., J.G.d.l.A., J.B.-L.), Microbiology (M.D.F.-L.), Intensive Care Unit (J.G.-G.), and Internal Medicine (B.A.-G.), University Hospital “12 de Octubre”; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); and Department of Medicine (M.D.F.-L., J.B.-L.), Universidad Complutense, Madrid, Spain.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Teresa Santos-Fernández, MD
From the Departments of Neurology (P.R.-S., L.B.-G., A.M.-G., J.P.-S., D.T.-A., D.S.-T., T.S.-F., J.G.d.l.A., J.B.-L.), Microbiology (M.D.F.-L.), Intensive Care Unit (J.G.-G.), and Internal Medicine (B.A.-G.), University Hospital “12 de Octubre”; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); and Department of Medicine (M.D.F.-L., J.B.-L.), Universidad Complutense, Madrid, Spain.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
María Dolores Folgueira-López, MD, PhD
From the Departments of Neurology (P.R.-S., L.B.-G., A.M.-G., J.P.-S., D.T.-A., D.S.-T., T.S.-F., J.G.d.l.A., J.B.-L.), Microbiology (M.D.F.-L.), Intensive Care Unit (J.G.-G.), and Internal Medicine (B.A.-G.), University Hospital “12 de Octubre”; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); and Department of Medicine (M.D.F.-L., J.B.-L.), Universidad Complutense, Madrid, Spain.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Judit Gutiérrez-Gutiérrez, MD https://orcid.org/0000-0001-9046-7306
From the Departments of Neurology (P.R.-S., L.B.-G., A.M.-G., J.P.-S., D.T.-A., D.S.-T., T.S.-F., J.G.d.l.A., J.B.-L.), Microbiology (M.D.F.-L.), Intensive Care Unit (J.G.-G.), and Internal Medicine (B.A.-G.), University Hospital “12 de Octubre”; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); and Department of Medicine (M.D.F.-L., J.B.-L.), Universidad Complutense, Madrid, Spain.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Blanca Ayuso-García, MD
From the Departments of Neurology (P.R.-S., L.B.-G., A.M.-G., J.P.-S., D.T.-A., D.S.-T., T.S.-F., J.G.d.l.A., J.B.-L.), Microbiology (M.D.F.-L.), Intensive Care Unit (J.G.-G.), and Internal Medicine (B.A.-G.), University Hospital “12 de Octubre”; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); and Department of Medicine (M.D.F.-L., J.B.-L.), Universidad Complutense, Madrid, Spain.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Jesús González de la Aleja, MD, PhD
From the Departments of Neurology (P.R.-S., L.B.-G., A.M.-G., J.P.-S., D.T.-A., D.S.-T., T.S.-F., J.G.d.l.A., J.B.-L.), Microbiology (M.D.F.-L.), Intensive Care Unit (J.G.-G.), and Internal Medicine (B.A.-G.), University Hospital “12 de Octubre”; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); and Department of Medicine (M.D.F.-L., J.B.-L.), Universidad Complutense, Madrid, Spain.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Julián Benito-León, MD, PhD
From the Departments of Neurology (P.R.-S., L.B.-G., A.M.-G., J.P.-S., D.T.-A., D.S.-T., T.S.-F., J.G.d.l.A., J.B.-L.), Microbiology (M.D.F.-L.), Intensive Care Unit (J.G.-G.), and Internal Medicine (B.A.-G.), University Hospital “12 de Octubre”; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); and Department of Medicine (M.D.F.-L., J.B.-L.), Universidad Complutense, Madrid, Spain.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE

Notes

Correspondence Dr. Benito-León [email protected]
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
*
These authors contributed equally to this work.

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  4. Myoclonus in patients with COVID‐19: Findings of autoantibodies against brain structures in cerebrospinal fluid, European Journal of Neurology, 30, 10, (3142-3148), (2023).https://doi.org/10.1111/ene.15958
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