Speech-activated myoclonus masquerading as stuttering
Citation Manager Formats
Make Comment
See Comments

Despite having had normal speech until age 21 when he contracted varicella encephalitis, this 53-year-old man had always considered himself a stutterer. Neurologic examination revealed lightning-like facial and neck contractions during speech, which were absent at rest (video). Brain and cervical spine MRI had normal results. Surface EMG confirmed intermittent high-amplitude, short-duration bursts suggestive of cortical myoclonus (figure and video).
Figure Surface EMG during speech and during grimacing
Surface EMG of the sternocleidomastoid and pharyngeal muscles during speech revealed short-duration, high-amplitude bursts (<100 msec) suggestive of cortical myoclonus (A). This is in contrast to the relatively prolonged bursts (>250 msec) of voluntary muscle contraction, as demonstrated when the patient voluntarily grimaced as quickly as possible (B).
Speech-activated myoclonus is an unusual variant of segmental action myoclonus.1,2 The etiology in this patient was likely postinfectious, and treatment with valproic acid led to a moderate symptomatic improvement. The myoclonus occurred with speech in both English and his native Ukrainian.
1 Slee M, Parasivam S, Blessing B, Truck K, Day B, Thyagarajan D. Speech-activated myoclonus: an uncommon form of action myoclonus. Mov Disord 2005;20:1120–1126.
2 Bartolomei F, Farnarier G, Elias Z, et al. Facial reflex myoclonus induced by language: a neuropsychological and neurophysiological study. Neurophysiol Clin 1999;29:263–270.OpenUrlCrossRefPubMed
Footnotes
-
Supplemental data at www.neurology.org.
Disclosure: Dr. Graham Alec Glass has received personal compensation for speaking and consulting on behalf of Allergan, Inc. UCSF Medical Center holds both an unrestricted educational grant and a research grant from Allergan, Inc.
Letters: Rapid online correspondence
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
You May Also be Interested in
Dr. Nicole Sur and Dr. Mausaminben Hathidara
► Watch
Topics Discussed
Alert Me
Recommended articles
-
WriteClick® Editor's Choice
Orthostatic myoclonus associated with Caspr2 antibodiesJay A. van Gerpen, Felix Gövert, J. Eric Ahlskog et al.Neurology, September 12, 2016 -
Articles
Orthostatic myoclonusA contributor to gait decline in selected elderlyGraham A. Glass, J. Eric Ahlskog, Joseph Y. Matsumoto et al.Neurology, March 14, 2007 -
Clinical/Scientific Notes
Orthostatic myoclonus associated with Caspr2 antibodiesFelix Gövert, Karsten Witt, Roberto Erro et al.Neurology, March 04, 2016 -
Clinical/Scientific Notes
BROWN-SÉQUARD SYNDROME AFTER HERPES ZOSTERC. Young-Barbee, D. A. Hall, J. J. LoPresti et al.Neurology, February 16, 2009