1016 Jerky Night: Propriospinal myoclonus at sleep onset after Metoclopramide use during pregnancy

Abstract Introduction Propriospinal myoclonus (PSM) at sleep onset is characterized by jerks of axial muscles, spreading caudally and rostrally, during the transition from wakefulness to sleep1. We present a rare case patient who suffered severe sleep-onset insomnia due PSM after metoclopramide use pregnancy. Report case(s) A 30-year-old woman with history well-controlled herpes simplex virus (HSV) resected atypical serous borderline ovarian tumor microinvasion, presented 2-year bout electrical, jerking sensations in her torso, legs just before falling asleep. The symptoms began an 18-week trial 20mg, for reflux esophagitis pregnancy, persisted discontinuation metoclopramide, postpartum, periodically worsening menses. On first presentation, neurological exam was unremarkable; polysomnography conducted, showing brief myoclonic upper extremity, increased EMG tone muscle artifact, preventing onset, allowing total time merely 1 hour 10 minutes. Event - related recordings on simultaneous electromyogram (EMG)/electroencephalogram (EEG), showed mixed movement disorder suggested mild CNS hyperexcitability some volitional jerks, jerks. An earlier clonazepam 1mg nightly partially improved symptoms, but caused panic, suicidal ideation, depression. Month-long, Diphenhydramine 50mg Trazodone 100mg initially helped insomnia, while Doxepin 10mg/mL, Daridorexant 25mg, Tizanidine, Gabapentin 900mg, Zolpidem, Cyclobenzaprine, Levetiracetam 500mg, Carbidopa-Levodopa, restriction all proved ineffective. Eventually, she underwent another 0.25mg slow titration 0.75mg adding melatonin 10mg, without adverse effects noted. Conclusion Our context Uniquely, were associated higher rapid Clonazepam, later lower dose slower titration, coupled Melatonin. Notably, both dopamine agonists antagonists, also cannabis, nitric oxide, interferon, ciprofloxacin, bupivacaine, spinal anesthesia, have reportedly medication-induced myoclonus. Further, reports similar cases may aid understanding better pathophysiology this rare, disabling condition, lead more rapid, effective treatment. Support (if any)