Involuntary craniofacial lingual movements in intensive care-acquired quadriplegia

Abstract

Background The syndrome of involuntary craniofacial lingual movements in the setting of acute intensive careacquired quadriplegia (critical illness neuromyopathy) following sepsis-associated encephalopathy has not been previously described. We suggest a localization and treatment for this disabling condition. Methods Three patients (2 female) from our center were quadriplegic from critical illness neuromyopathy when they developed involuntary craniofacial lingual movements following sepsis-associated encephalopathy. Results 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. Conclusions Involuntary craniofacial lingual movements in the setting of flaccid quadriplegia following sepsisassociated encephalopathy are consistent with focal craniofacial brainstem myoclonus and constitutes a new syndrome. Botulinum toxin type A treatment maybe helpful in treatment. © 2011 Springer Science+Business Media, LLC.