Opercular myoclonic-anarthric status epilepticus: A report of two cases
A 75-year-old, right-handed male patient presented with acute onset of abnormal, involuntary movements of soft palate, tongue, lips and jaw for the last 3 days. He had speech disturbances and swallowing difficulty, occasionally associated with choking episodes. He had no difficulty in voluntary movements of facial, palatal muscles and tongue. There was no history of diabetes mellitus or hypertension. He was a chronic smoker (30 pack years) and occasionally consumed alcohol.\nOn general physical examination, vital data was normal except for elevated blood pressure (170/100 mmHg). Neurological examination revealed that speech was slow and dysarthric and bilateral, symmetrical, involuntary, continuous, repetitive and synchronized rhythmic myoclonus involving soft palate, lips, chin, tongue and jaw at a rate of 60-80/min []; rest of the neurological examination was unremarkable.\nLaboratory investigations including hemogram, serum biochemistry and 2D-echocardiogram were normal. Carotid/vertebral arterial Doppler study showed thrombosis of left internal carotid artery. Electroencephalogram (EEG) was normal []. Magnetic resonance imaging (MRI) of brain, diffusion weighted axial image (DWI) showed restriction in left frontal opercular cortex suggesting an acute infarct []. Magnetic resonance angiography (MRA) of the brain showed thrombosis of left internal carotid artery.\nHe was treated with oral clonazepam (0.5 mg twice daily), gabapentin (100 mg 3 times daily) for palatal myoclonus; oral aspirin (150 mg once daily) and rosuvastatin (5 mg once daily) for ischemic stroke; and oral amlodipine (2.5 mg once daily) for hypertension control. Long-term warfarin therapy was also prescribed. During hospital stay myoclonus improved over a period of 5-7 days []. Speech disorder gradually improved in 8-10 days. During the follow-up period of 1 year, the patient had no recurrence of myoclonus.