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Improvements in Symptom Severity and Stability Following Neurological Rehabilitation of a 24-year-old Female Patient with Myoclonus-Dystonia



Emily R. Kalambaheti1*, Megan Manno2, Matthew M. Antonucci1, 3 and Paul E. Link1

1Plasticity Brain Centers, United States

2University of Central Florida, United States

3Carrick Institute, United States

Presentation: A 24-year-old female presented to Plasticity Brain Centers for evaluation and treatment of Myoclonus-dystonia. Myoclonus-dystonia (M-D) is a movement disorder characterized by a combination of rapid, brief muscle contractions (myoclonus) and/or sustained twisting and repetitive movements that result in abnormal postures (dystonia) (Raymond 2003). Her symptoms included rapid movements in the neck, right arm, and right leg, headaches, balance problems, difficulty concentrating, sensitivity to hard noises provoking movement, and extreme fatigue.

Findings: When asked to rate her symptoms on a graded symptom checklist (GSC) (Simon 2017), she reported a score of 110. A Comprehensive Assessment of Postural Systems (CAPS®) (Pagnacco 2014) was performed assessing balance and stability, on a solid and foamed surface, with eyes opened. Her average stability score was 45.619%. This stability score is affected by the pathological movements, as characterized in her (M-D), which lowers her overall stability score.

Methods: An 8-day, multi-modal program of neurological exercises was administered in 18 one-hour treatment sessions (Carrick 2017) that consisted of repetitive peripheral somatosensory stimuli, neuromuscular reeducation exercises, vestibular rehabilitation exercises, orthoptic exercises, cognitive exercises, cold laser, soft tissue mobilization, and off-vertical axis rotation (Gdowski 1999) utilizing a multi-axis rotational chair (MARC).

Outcome: Upon exit, her symptoms score was 59 (-46.3636%). Her average stability score improved to 62.132% (+36.20%). She stated that the myoclonic activity was no longer present in her leg and the size of the movements had decreased. The improved stability score supports this qualitative statement.

Conclusion: The authors suggest that multi-modal program of neurological exercise may be a viable intervention to address symptoms and stability in patients with M-D. The authors also suggest further investigation into multi-modal, intensive neurological approaches for patients with M-D.

References:

  1. Carrick FR, Clark JF, Pagnacco G, Antonucci MM, Hankir A, Zaman R and Oggero E (2017) Head–Eye Vestibular Motion Therapy Affects the Mental and Physical Health of Severe Chronic Postconcussion Patients. Front. Neurol. 8:414. doi: 10.3389/fneur.2017.00414  
  2. Gdowski GT, McCrea RA. Integration of vestibular and head movement signals in the vestibular nuclei during whole-body rotation. J Neurophysiol (1999) 82:436–49  
  3. Pagnacco G, Carrick FR, Wright CH, Oggero E. In-situ verification of accuracy, precision and resolution of force and balance platforms. Biomed Sciences instrumentation (2014) 50:171-8  
  4. Raymond D, Ozelius L. Myoclonus-Dystonia. 2003 May 21 [Updated 2012 Jan 26]. In: Adam MP, Ardinger HH, Pagon RA, et al., editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993-2018. Available from: https://www.ncbi.nlm.nih.gov/books/NBK1414/  
  5. Simon M, Maerlender A, Metzger K, Decoster L, Hollingworth A, McLeod TV. Reliability and Concurrent Validity of Select C3 Logix Test Components. Developmental Neuropsychology (2017) Oct; 0: 1-14. Doi: 10.1080/87565641.2017.1383994. Epub 2017 Oct 25.

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