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Improving Neurophysiological Biomarkers for Functional Myoclonic Movements

Beudel, M; zutt, R; meppelink, A-M; Little, SJ; Elting, J; Stelten, B; Edwards, M; (2018) Improving Neurophysiological Biomarkers for Functional Myoclonic Movements. Parkinsonism & Related Disorders , 51 pp. 3-8. 10.1016/j.parkreldis.2018.03.029. Green open access

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Introduction Differentiating between functional jerks (FJ) and organic myoclonus can be challenging. At present, the only advanced diagnostic biomarker to support FJ is the Bereitschaftspotential (BP). However, its sensitivity is limited and its evaluation subjective. Recently, event related desynchronisation in the broad beta range (13–45 Hz) prior to functional generalised axial (propriospinal) myoclonus was reported as a possible complementary diagnostic marker for FJ. Here we study the value of ERD together with a quantified BP in clinical practice. Methods Twenty-nine patients with FJ and 16 patients with cortical myoclonus (CM) were included. Jerk-locked back-averaging for determination of the ‘classical’ and quantified BP, and time-frequency decomposition for the event related desynchronisation (ERD) were performed. Diagnostic gain, sensitivity and specificity were obtained for individual and combined techniques. Results We detected a classical BP in 14/29, a quantitative BP in 15/29 and an ERD in 18/29 patients. At group level we demonstrate that ERD in the broad beta band preceding a jerk has significantly higher amplitude in FJ compared to CM (respectively −0.14 ± 0.13 and +0.04 ± 0.09 (p < 0.001)). Adding ERD to the classical BP achieved an additional diagnostic gain of 53%. Furthermore, when combining ERD with quantified and classical BP, an additional diagnostic gain of 71% was achieved without loss of specificity. Conclusion Based on the current findings we propose to the use of combined beta ERD assessment and quantitative BP analyses in patients with a clinical suspicion for all types of FJ with a negative classical BP.

Type: Article
Title: Improving Neurophysiological Biomarkers for Functional Myoclonic Movements
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.parkreldis.2018.03.029
Publisher version: https://doi.org/10.1016/j.parkreldis.2018.03.029
Language: English
Additional information: This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0
Keywords: Neurophysiological biomarkers, Bereitschaftspotential, Event related desynchronisation, Functional myoclonic jerks
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
URI: https://discovery.ucl.ac.uk/id/eprint/10046258
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