Focal reflex myoclonus

In a patient with reflex myoclonus limited to the right side of the body, stimulation of the right median nerve in the index finger or wrist elicited a very large somatosensory evoked response (SER) and a long loop C reflex which represents an electrically evoked myoclonic response. It is suggested that the pathway for the C reflex is through peripheral nerve, dorsal funiculus of spinal cord, contralateral VP nucleus of thalamus, sensorimotor cortex, corticospinal tract, and anterior horn cell. The large SER, C reflex, and myoclonic jerks are presumed to result from a release effect causing increased excitability at central synapses along this pathway. The patient presented has a large atrophic vascular lesion involving the left frontotemporoparietal region and involvement of pathways through the right superior cerebellar peduncle to account for the neural dysfunction.