Response of spinal myoclonus to a combination therapy of autogenic training and biofeedback

Abstract

Introduction: Clinical evidence indicates that certain types of movement disorders are due to psychosomatic factors. Patients with myoclonic movements are usually treated by a variety of therapeutic agents. Autogenic training (AT), a recognized form of psychosomatic therapies, is suitable for certain types of neurological diseases. We describe a patient with myoclonus who failed to respond to conventional medical therapy. His symptoms were exaggerated by psychogenic factors, especially anger.

Case presentation: A 42-year-old man was admitted to our hospital, Preventive Welfare Clinic, for severe paroxysmal axial myoclonus of the left shoulder and abdominal muscles. The initial diagnosis was "combination of spinal segmental myoclonus and propriospinal myoclonus". The myoclonic movements did not occur during sleep but were aggravated by bathing, alcohol drinking, and anger. Psychological examination indicated hostile attribution. Although considered not to be a case of psychogenic myoclonus, a "psychogenic factor" was definitely involved in the induction of the organic myoclonus. The final diagnosis was "combination of spinal segmental myoclonus and propriospinal myoclonus accompanied by features of psychosomatic disorders". The patient underwent psychosomatic therapy including AT and surface electromyography (EMG)-biofeedback therapy and treatment with clonazepam and carbamazepine.

Results: AT and EMG-biofeedback resulted in shortening the duration and reducing the amplitude and frequency of the myoclonic discharges.

Conclusion: Psychosomatic therapy with AT and surface EMG-biofeedback produced excellent improvement of myoclonic movements and allowed the reduction of the dosage of conventional medications.

Figure 1

Photograph of surface EMG monitoring during autogenic training (AT). The patient was prepared by placing the electrodes on the left major pectoral and abdominal rectal muscles (green circles). The references and ground electrodes were placed on the right and left shoulder, respectively. Patient did AT training using a cassette tape recorder for 5 min, 3 times a day. During AT, the patient could watch the myoclonic jerks on the surface EMG recorder, which served as a biomechanical feedback.

Figure 2

Representative records of surface EMG. Representative records of surface EMG from the left major pectoral (record 1) and left abdominal rectal muscles (record 2). Records of first trial of AT appear as Pre AT (A: before AT first trial) and During AT (B). Records after 16 days of AT training are marked as Before AT (C) and During AT (D). Myoclonic discharges are shown in red. Both the duration and amplitude of myoclonic discharges were decreased by AT after 16 days of AT training.

Figure 3

Frequency of myoclonus in 5 min. Frequency of myoclonus discharges within 5 min decreased progressively and significantly from 80 to about 34 at day 16 after the commencement of AT training.