A case report of rigidity and recurrent lower limb myoclonus: Progressive encephalomyelitis rigidity and myoclonus syndrome, a chameleon

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Abstract

Background: Progressive encephalomyelitis with rigidity and myoclonus (PERM) syndrome is a rare neurological condition. Its clinical characteristics include axial and limb muscle rigidity, myoclonus, painful spasms and hyperekplexia. Diagnosis of this disease can be very challenging and optimal long-term treatment is unclear. Case presentation: We report a case of a 62 year old patient admitted for repetitive myoclonus and rigidity in the lower limbs progressing since 10 years, associated with a fluctuating encephalopathy requiring stays in Intensive Care Unit. Multiple diagnostics and treatment were proposed, unsuccessfully, before the diagnosis of PERM syndrome was established. In association with the clinical presentation, a strong positive result for GAD (glutamic acid decarboxylase) antibodies lead to the diagnosis of PERM syndrome. Conclusions: PERM syndrome is a rare disease and its diagnosis is not easy. Once the diagnosis is established, the correct treatment should follow and could be lifesaving, regardless of a delayed diagnosis. Maintenance of long-term oral corticotherapy is suggested to prevent relapses.

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Degeneffe, A., Dagonnier, M., D’Hondt, A., & Elosegi, J. A. (2018). A case report of rigidity and recurrent lower limb myoclonus: Progressive encephalomyelitis rigidity and myoclonus syndrome, a chameleon. BMC Neurology, 18(1). https://doi.org/10.1186/s12883-018-1176-3

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