Involuntary Craniofacial Lingual Movements in Intensive Care-Acquired Quadriplegia
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The syndrome of involuntary craniofacial lingual movements in the setting of acute intensive care-acquired quadriplegia (critical illness neuromyopathy) following sepsis-associated encephalopathy has not been previously described. We suggest a localization and treatment for this disabling condition.
Three patients (2 female) from our center were quadriplegic from critical illness neuromyopathy when they developed involuntary craniofacial lingual movements following sepsis-associated encephalopathy.
Extensive investigations failed to identify an etiology for the abnormal movements. Movements were of large amplitude, of moderate speed, and semi-rhythmic in the jaw, tongue, and palate, persistent and extremely bothersome to all patients. Injection with Botulinum toxin type A was very beneficial.
Involuntary craniofacial lingual movements in the setting of flaccid quadriplegia following sepsis-associated encephalopathy are consistent with focal craniofacial brainstem myoclonus and constitutes a new syndrome. Botulinum toxin type A treatment maybe helpful in treatment.
KeywordsMyoclonus Critical illness neuromyopathy Sepsis Neurocritical care
Video 1: Case 1. The patient is affected with ICU-acquired quadriplegia and is exhibiting debilitating involuntary cranio-facial lingual movements; before injection of botulinum toxin A. (WMV 1957 kb)
Video 2: Case 1. The patient after injection of botulinum toxin A; showing much less involuntary cranio-facial lingual movements and able to follow simple commands. (WMV 2992 kb)