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Journal of Anesthesia

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06.01.2019 | Review Article

Spinal myoclonus following neuraxial anesthesia: a literature review

verfasst von: Tohru Shiratori, Kunihisa Hotta, Masaaki Satoh

Erschienen in: Journal of Anesthesia | Ausgabe 1/2019

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Abstract

Spinal myoclonus (SM) is a rare neurologic movement disorder following neuraxial anesthesia (NA). SM following NA (SM-NA) has insufficient clinical information and its pathogenesis remains to be elucidated. The aim of this review article was to summarize the past cases and consider SM-NA pathophysiology. Based on our PubMed search, it was revealed that SM-NA develops within several hours after neuraxial local anesthetic (LA) administration and resolves in a day without leaving neurologic compilations. It occurs primarily in the lower extremities, but can sometimes spread upward and affect the upper extremities and trunk. Although statistical adjustments are indispensable, analysis of the previous cases provided important facts that seem to be related with the mechanism of SM-NA. The frequently used LAs for spinal anesthesia were hyperbaric. SM-NA occurrence was more frequent in women. After initiation of spinal anesthesia, intrathecal hyperbaric LA distributes cephalad. In the LA elimination process, the large concentration differences in intrathecal LA may induce the partially functioning spinal neurons, resulting in myoclonus generation. The morphological features of the lumbar spine in women can predispose to a higher LA concentration difference. SM-NA is an unpredictable and rare neural complication following NA and should be confirmed by basic experiments and large-scale researches.

Brull R, Macfarlane AJR, Chan VWS. Spinal, epidural, and caudal anesthesia. In: Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Cohen NH, Young WL, editors. Miller’s anesthesia, 2-volume set. 8th ed. Philadelphia: Elsevier; 2014. pp. 1684–720.

Mordecai MM, Brull SJ. Spinal anesthesia. Curr Opin Anaesthesiol. 2005;18:527–33.CrossRefPubMed

Brull R, McCartney CJL, Chan VWS, El-Beheiry H. Neurological complications after regional anesthesia: contemporary estimates of risk. Anesth Analg. 2007;104:965–74.CrossRefPubMed

Moen V, Dahlgren N, Irestedt L. Severe neurological complications after central neuraxial blockades in Sweden 1990–1999. Anesthesiology. 2004;101:950–9.CrossRefPubMed

Shiratori T, Hotta K, Satoh M, Kondo N, Ikeda J, Sasao S. A case of spinal myoclonus in a patient with elective cesarean section. JA Clin Rep. 2018;4:47. https://doi.org/10.1186/s40981-018-0182-1.CrossRef

Termsarasab P, Frucht SJ. Myoclonus. In: Louis ED, Mayer SA, Rowland LP, editors. Merritt’s neurology. 13th ed. Philadelphia: Wolters Kluwer; 2016. pp. 660–5.

Kojovic M, Cordivari C, Bhatia K. Myoclonic disorders: a practical approach for diagnosis and treatment. Ther Adv Neurol Disord. 2011;4:47–62. https://doi.org/10.1177/1756285610395653.CrossRefPubMedPubMedCentral

Fahn S, Frucht S. Myoclonus. In: Rowland LP, Pedley TA, editors. Merritt’s neurology. 12th ed. Philadelphia: Wolters Kluwer; 2010. pp. 732–3.

Rothwell JC. Pathophysiology of spinal myoclonus. Adv Neurol. 2002;89:137–44.PubMed

10.

Hoehn MM, Cherington M. Spinal myoclonus. Neurology. 1977;27:942–6.CrossRefPubMed

11.

Termsarasab P, Thammongkolchai T, Frucht SJ. Spinal-generated movement disorders: a clinical review. J Clin Mov Disord. 2015;2:18.CrossRefPubMedPubMedCentral

12.

Fox EJ, Villanueva R, Schutta HS. Myoclonus following spinal anesthesia. Neurology. 1979;29:379–80.CrossRefPubMed

13.

Watanabe S, Sakai K, Ono Y, Seino H, Naito H. Alternating periodic leg movement induced by spinal anesthesia in an elderly male. Anesth Analg. 1987;66:1031–2.CrossRefPubMed

14.

Watanabe S, Ono A, Naito H. Periodic leg movements during either epidural or spinal anesthesia in an elderly man without sleep-related (nocturnal) myoclonus. Sleep. 1990;13:262–6.PubMed

15.

Nadkarni AV, Tondare AS. Localized clonic convulsions after spinal anesthesia with lidocaine and epinephrine. Anesth Analg. 1982;61:945–7.CrossRefPubMed

16.

Almedallah DK, Alshamlan DY, Shariff EM. Acute opioid-induced myoclonic reaction after use of fentanyl as an anesthetic drug for an emergency cesarean section. Case Rep Neurol. 2018;10:130–4. https://doi.org/10.1159/000486891.CrossRefPubMedPubMedCentral

17.

Lev A, Korn-Lubezki I, Steiner-Birmanns B, Samueloff A, Gozal Y, Ioscovich A. Prolonged propriospinal myoclonus following spinal anesthesia for cesarean section: case report and literature review. Arch Gynecol Obstet. 2012;286:271–2.CrossRefPubMed

18.

Fores Novales B, Aguilera Celorrio L. Spinal myoclonus following intrathecal anaesthesia with prilocaine. Anaesth Intensive Care. 2009;37:498–9.PubMed

19.

Lin CS, Wei-Hung C, Lee YW. Transient spinal myoclonus after spinal anaesthesia with bupivacaine in the perioperation period. Anaesthesist. 2008;57:518.CrossRefPubMed

20.

Lee JJ, Hwang SM, Lee JS, Jang JS, Lim S-Y, Hong SJ. Recurrent spinal myoclonus after two episodes of spinal anesthesia at a 1-year interval—a case report. Korean J Anesthesiol. 2010;59 Suppl:62–4.CrossRef

21.

Abrão J, Bianco MP, Roma W, Krippa JES, Hallak JE. Spinal myoclonus after subarachnoid anesthesia with bupivacaine. Rev Bras Anestesiol. 2011;61:619–23.CrossRefPubMed

22.

Kösem B, Kılınç H. An unusual complication of anesthesia: unilateral spinal myoclonus. Agri. 2017;29:90–1.PubMed

23.

Bamgbade OA, Alfa JA, Khalaf WM, Zuokumor AP. Central neuraxial anaesthesia presenting with spinal myoclonus in the perioperative period: a case series. J Med Case Reports. 2009;3:7293.CrossRefPubMedCentral

24.

Zamidei L, Bandini M, Michelagnoli G, Campostrini R, Consales G. Propriospinal myoclonus following intrathecal bupivacaine in hip surgery: a case report. Minerva Anestesiol. 2010;76:290–3.PubMed

25.

Ji TT, Shih CK, Hsieh YJ, Sun WZ. Desultory propriospinal myoclonus after epidural analgesia in a healthy parturient. Int J Obstet Anesth. 2015;24:285–6.CrossRefPubMed

26.

Celik Y, Bekir Demirel C, Karaca S, Kose Y. Transient segmental spinal myoclonus due to spinal anaesthesia with bupivacaine. J Postgrad Med. 2003;49:286.PubMed

27.

Nakamoto T, Hirota K, Iwai T, Shingu K. Complete resolution of myoclonus-like involuntary movements under subarachnoid block after midazolam administration in a patient undergoing cesarean section: a case report. Korean J Anesthesiol. 2015;68:193–5.CrossRefPubMedPubMedCentral

28.

Kang HY, Lee SW, Hong EP, Sim YH, Lee S-M, Park SW, Kang J-M. Myoclonus-like involuntary movements following cesarean delivery epidural anesthesia. J Clin Anesth. 2016;34:392–4.CrossRefPubMed

29.

Alfa JA, Bamgbade OA. Acute myoclonus following spinal anaesthesia. Eur J Anaesthesiol. 2008;25:256–7.CrossRefPubMed

30.

van der Salm SMA, Erro R, Cordivari C, Edwards MJ, Koelman JHTM, van den Ende T, Bhatia KP, van Rootselaar A-F, Brown P, Tijssen MAJ. Propriospinal myoclonus: clinical reappraisal and review of literature. Neurology. 2014;83:1862–70. https://doi.org/10.1212/WNL.0000000000000982.CrossRefPubMedPubMedCentral

31.

Oguri T, Hisatomi K, Kawashima S, Ueki Y, Tachibana N, Matsukawa N. Postsurgical propriospinal myoclonus emerging at wake to sleep transition. Sleep Med. 2014;15:152–4.CrossRefPubMed

32.

Hachisuka K, Ogata H, Kohshi K. Post-operative paraplegia with spinal myoclonus possibly caused by epidural anaesthesia: case report. Paraplegia. 1991;29:131–6.PubMed

33.

Dreskin S, Bajwa ZH, Lehmann L, Warfield CA. Polymyoclonus resulting from possible accidental subdural injection of local anesthetic. Anesth Analg. 1997;84:692–3.PubMed

34.

Menezes FV, Venkat N. Spinal myoclonus following combined spinal-epidural anaesthesia for caesarean section. Anaesthesia. 2006;61:597–600.CrossRefPubMed

35.

Ford B, Pullman SL, Khandji A, Goodman R. Spinal myoclonus induced by an intrathecal catheter. Mov Disord. 1997;12:1042–5.CrossRefPubMed

36.

Wong SSC, Qiu Q, Cheung CW. Segmental spinal myoclonus complicating lumbar transforaminal epidural steroid injection. Reg Anesth Pain Med. 2018;43:554–6. https://doi.org/10.1097/AAP.0000000000000742.CrossRefPubMed

37.

Parkinson SK, Bailey SL, Little WL, Mueller JB. Myoclonic seizure activity with chronic high-dose spinal opioid administration. Anesthesiology. 1990;72:743–5.CrossRefPubMed

38.

Cartwright PD, Hesse C, Jackson AO. Myoclonic spasms following intrathecal diamorphine. J Pain Symp Manage. 1993;8:492–5.CrossRef

39.

Kloke M, Bingel U, Seeber S. Complications of spinal opioid therapy: myoclonus, spastic muscle tone and spinal jerking. Support Care Cancer. 1994;2:249–52.CrossRefPubMed

40.

Jeon Y, Baek SU, Yeo JS. Spinal myoclonus developed during cervical epidural drug infusion in postherpetic neuralgia patient. Korean J Pain. 2011;24:169–71.CrossRefPubMedPubMedCentral

41.

Batra YK, Rajeev S, Lokesh VC, Rao KLN. Spinal myoclonus associated with intrathecal bupivacaine and fentanyl in an infant. Can J Anaesth. 2007;54:587–8.CrossRefPubMed

42.

Jankovic J, Lang AE. Movement disorders: diagnosis and assessment. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, editors. Bradley’s neurology in clinical practice. 6th ed. Philadelphia: Elsevier; 2012. pp. 230–59.CrossRef

43.

Juvin L, Simmers J, Morin D. Propriospinal circuitry underlying interlimb coordination in mammalian quadrupedal locomotion. J Neurosci. 2005;25:6025–35.CrossRefPubMed

44.

Cohen EN. Distribution of local anesthetic agents in the neuraxis of the dog. Anesthesiology. 1968;29:1002–5.CrossRefPubMed

45.

Park CK, Choi HY, Oh IY, Kim MS. Acute dystonia by droperidol during intravenous patient-controlled analgesia in young patients. J Korean Med Sci. 2002;17:715–7.CrossRefPubMedPubMedCentral

46.

Melnick BM. Extrapyramidal reactions to low-dose droperidol. Anesthesiology. 1988;69:424–6.CrossRefPubMed

47.

Fahn S. Dystonia. In: Louis ED, Mayer SA, Rowland LP, editors. Merritt’s neurology. 13th ed. Philadelphia: Wolters Kluwer; 2016. pp. 644–56.

48.

Kang UJ, Burke RE, Fahn S. Tardive dyskinesia and other neuroleptic-induced syndromes. In: Louis ED, Mayer SA, Rowland LP, editors. Merritt’s neurology. 13th ed. Philadelphia: Wolters Kluwer; 2016. pp. 686–90.

49.

Kitahara T, Kuri S, Yoshida J. The spread of drugs used for spinal anesthesia. Anesthesiology. 1956;17:205–8.CrossRefPubMed

50.

Hay O, Dar G, Abbas J, Stein D, May H, Masharawi Y, Peled N, Hershkovitz I. The lumbar lordosis in males and females, revisited. PLoS ONE. 2015;10:e0133685.CrossRefPubMedPubMedCentral

51.

Schiffer E, Van Gessel E, Gamulin Z. Influence of sex on cerebrospinal fluid density in adults. Br J Anaesth. 1999;83:943–4.CrossRefPubMed

52.

Yuan H, Goto N, Goto J, Shiraishi N, Shimada S. Sexual dimorphism of the human spinal cord in the aging process. Okajimas Folia Anat Jpn. 1999;76:241–6.CrossRefPubMed

53.

Yuan H, Goto N, Akita H, Goto J, Jīn SR. Sexual dimorphism of the motoneurons in the human spinal cord. Okajimas Folia Anat Jpn. 2000;77:143–8.CrossRefPubMed

54.

Papinutto N, Schlaeger R, Panara V, Zhu AH, Caverzasi E, Stern WA, Hauser SL, Henry RG. Age, gender and normalization covariates for spinal cord gray matter and total cross-sectional areas at cervical and thoracic levels: a 2D phase sensitive inversion recovery imaging study. PloS One. 2015;10:e0118576.CrossRefPubMedPubMedCentral

Titel: Spinal myoclonus following neuraxial anesthesia: a literature review
verfasst von: Tohru Shiratori
Kunihisa Hotta
Masaaki Satoh
Publikationsdatum: 06.01.2019
Verlag: Springer Japan
Erschienen in: Journal of Anesthesia / Ausgabe 1/2019
Print ISSN: 0913-8668
Elektronische ISSN: 1438-8359
DOI: https://doi.org/10.1007/s00540-018-02607-z

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Spinal myoclonus following neuraxial anesthesia: a literature review

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