Myoclonus and cerebellar ataxia associated with COVID-19: a case report and systematic review

• Published in: Journal of neurology Vol. 268; no. 10; pp. 3517 - 3548
• Main Authors: Chan, Jason L., Murphy, Keely A., Sarna, Justyna R.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2021; Springer Nature B.V
• Subjects: Ataxia; Ataxia - complications; Case reports; Cerebellar ataxia; Cerebellar Ataxia - complications; Cerebellum; Cognitive ability; Coronaviruses; COVID-19; Epilepsy; Female; Humans; Immunotherapy; Medicine; Medicine & Public Health; Middle Aged; Miller-Fisher syndrome; Movement disorders; Myoclonus; Myoclonus - etiology; Neurology; Neuroradiology; Neurosciences; Pandemics; Review; SARS-CoV-2; Systematic review; SARS-CoV-2; Post-infectious; Cortical; Movement disorders; Subcortical; Central nervous system
• ISSN: 0340-5354; 1432-1459
• DOI: 10.1007/s00415-021-10458-0

Background Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic in December 2019, neurological manifestations have been recognized as potential complications. Relatively rare movement disorders associated with COVID-19 are increasingly reported in case reports or case series. Here, we present a case and systematic review of myoclonus and cerebellar ataxia associated with COVID-19. Methods A systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline using the PubMed and Ovid MEDLINE databases, from November 1, 2019 to December 6, 2020. Results 51 cases of myoclonus or ataxia associated with COVID-19, including our case, were identified from 32 publications. The mean age was 59.6 years, ranging from 26 to 88 years, and 21.6% were female. Myoclonus was multifocal or generalized and had an acute onset, usually within 1 month of COVID-19 symptoms. Myoclonus occurred in isolation (46.7%), or with ataxia (40.0%) or cognitive changes (30.0%). Most cases improved within 2 months, and treatment included anti-epileptic medications or immunotherapy. Ataxia had an acute onset, usually within 1 month of COVID-19 symptoms, but could be an initial symptom. Concurrent neurological symptoms included cognitive changes (45.5%), myoclonus (36.4%), or a Miller Fisher syndrome variant (21.2%). Most cases improved within 2 months, either spontaneously or with immunotherapy. Conclusions This systematic review highlights myoclonus and ataxia as rare and treatable post-infectious or para-infectious, immune-mediated phenomena associated with COVID-19. The natural history is unknown and future investigation is needed to further characterize these movement disorders and COVID-19.