Spinal myoclonus following neuraxial anesthesia: a literature review
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.
KeywordsMovement disorder Involuntary movement Myoclonus Local anesthetic Neuraxial anesthesia
This research did not receive any specific grants from funding agencies in the public, commercial, or not-for-profit sectors. We gratefully acknowledge Toyomi Kamesaki (Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University). The authors also thank the Clinical Research Support Team Jichi (CRST) in Jichi Medical University for their advice.
TS, KH, and MS wrote the manuscript. KH and MS revised the manuscript. KH supervised this work. TS prepared manuscript files. All authors reviewed and approved the final manuscript for submission.
- 1.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.Google Scholar
- 6.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.Google Scholar
- 8.Fahn S, Frucht S. Myoclonus. In: Rowland LP, Pedley TA, editors. Merritt’s neurology. 12th ed. Philadelphia: Wolters Kluwer; 2010. pp. 732–3.Google Scholar
- 9.Rothwell JC. Pathophysiology of spinal myoclonus. Adv Neurol. 2002;89:137–44.Google Scholar
- 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.Google Scholar
- 18.Fores Novales B, Aguilera Celorrio L. Spinal myoclonus following intrathecal anaesthesia with prilocaine. Anaesth Intensive Care. 2009;37:498–9.Google Scholar
- 22.Kösem B, Kılınç H. An unusual complication of anesthesia: unilateral spinal myoclonus. Agri. 2017;29:90–1.Google Scholar
- 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.Google Scholar
- 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.Google Scholar
- 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.CrossRefGoogle Scholar
- 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.Google Scholar
- 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.Google Scholar
- 47.Fahn S. Dystonia. In: Louis ED, Mayer SA, Rowland LP, editors. Merritt’s neurology. 13th ed. Philadelphia: Wolters Kluwer; 2016. pp. 644–56.Google Scholar
- 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.Google Scholar
- 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.CrossRefGoogle Scholar