RESIDENT & FELLOW SECTION Section Editor Mitchell S.V. Elkind, MD, MS Brian H. Walsh, MB BCh, PhD Fiona M. Baumer, MD Miya E. Bernson-Leung, MD Paul Lerou, MD Jurriaan M. Peters, MD Teaching Video NeuroImages: Nonepileptic myoclonus in a neonate following severe hypoxic-ischemic injury Figure Amplitude-integrated EEG Correspondence to Dr. Walsh: brian.walsh2@childrens.harvard. edu Amplitude-integrated EEG monitoring shows transient increases in amplitude concerning for possible seizures (red arrows) in contrast to baseline (black arrows). Concurrent raw EEG trace (dashed lines) shows an intermittent rhythmic pattern timelocked to the paroxysmal limb movements. Supplemental data at Neurology.org A newborn boy had a profound hypoxic-ischemic insult at birth. He developed rhythmic myoclonus within 1 hour, which was initially assumed to be seizures, but was unresponsive to escalating antiepileptic therapy. On careful examination, it was evident that myoclonus could be induced and suppressed. Amplitude-integrated (figure) and video EEG (video on the Neurology® Web site at Neurology.org) demonstrated a suppressed background with intermittent rhythmic pattern correlating with the movements. Laterality of this pattern changed with head positioning, suggesting artifact from pressure on dependent electrodes. Care was ultimately redirected when neuroimaging confirmed severe injury. Nonepileptic myoclonus is a brainstem release phenomena1 that can be difficult to distinguish from seizures without detailed clinical examination combined with EEG.2 Timely diagnosis can prevent unnecessary treatment and can inform prognosis. AUTHOR CONTRIBUTIONS Dr. Walsh drafted the manuscript, created the figure, and approved all final changes. Dr. Baumer edited the manuscript, created the PowerPoint, and approved all final changes. Dr. Bernson-Leung edited the manuscript and approved all final changes. Dr. Lerou edited the manuscript and approved all final changes. Dr. Peters edited the manuscript, created the video file, and approved all final changes. STUDY FUNDING No targeted funding reported. DISCLOSURE B. Walsh and F. Baumer report no disclosures. M. Bernson-Leung is a member of the Editorial Board of the Neurology® Resident & Fellow Section. P. Lerou and J. Peters report no disclosures. Go to Neurology.org for full disclosures. REFERENCES 1. Huntsman RJ, Lowry NJ, Sankaran K. Nonepileptic motor phenomena in the neonate. Paediatr Child Health 2008;13: 680–684. 2. Mizrahi EM, Kellaway P. Characterization and classification of neonatal seizures. Neurology 1987;37:1837–1844. Download teaching slides: Neurology.org From the Division of Newborn Medicine (B.H.W.) and the Department of Neurology (F.M.B., M.E.B.-L., J.M.P.), Boston Children’s Hospital; and the Department of Pediatric Newborn Medicine (B.H.W., P.L.), Brigham and Women’s Hospital, Boston, MA. e90 © 2015 American Academy of Neurology ª 2015 American Academy of Neurology. Unauthorized reproduction of this article is prohibited. Teaching Video NeuroImages: Nonepileptic myoclonus in a neonate following severe hypoxic-ischemic injury Brian H. Walsh, Fiona M. Baumer, Miya E. Bernson-Leung, et al. Neurology 2015;84;e90 DOI 10.1212/WNL.0000000000001397 This information is current as of March 23, 2015 Neurology ® is the official journal of the American Academy of Neurology. Published continuously since 1951, it is now a weekly with 48 issues per year. Copyright © 2015 American Academy of Neurology. All rights reserved. Print ISSN: 0028-3878. Online ISSN: 1526-632X. Updated Information & Services including high resolution figures, can be found at: http://www.neurology.org/content/84/12/e90.full.html Supplementary Material Supplementary material can be found at: http://www.neurology.org/content/suppl/2015/03/21/WNL.000000000 0001397.DC1.html http://www.neurology.org/content/suppl/2015/03/21/WNL.000000000 0001397.DC2.html References This article cites 2 articles, 1 of which you can access for free at: http://www.neurology.org/content/84/12/e90.full.html##ref-list-1 Subspecialty Collections This article, along with others on similar topics, appears in the following collection(s): EEG http://www.neurology.org//cgi/collection/eeg_ Myoclonus http://www.neurology.org//cgi/collection/myoclonus Myoclonus; see Movement Disorders/myoclonus http://www.neurology.org//cgi/collection/myoclonus_see_movement_d isorders-myoclonus Neonatal http://www.neurology.org//cgi/collection/neonatal Neonatal seizures http://www.neurology.org//cgi/collection/neonatal_seizures Permissions & Licensing Information about reproducing this article in parts (figures,tables) or in its entirety can be found online at: http://www.neurology.org/misc/about.xhtml#permissions Reprints Information about ordering reprints can be found online: http://www.neurology.org/misc/addir.xhtml#reprintsus Neurology ® is the official journal of the American Academy of Neurology. Published continuously since 1951, it is now a weekly with 48 issues per year. Copyright © 2015 American Academy of Neurology. All rights reserved. Print ISSN: 0028-3878. Online ISSN: 1526-632X.