Objective: We describe a case of episodic, painful arm spasms with involuntary tremulous movements, after remote electrocution injury.

Background: A variety of movement disorders have been associated with peripheral trauma, often overlapping with complex regional pain syndrome (CRPS). However, published cases of movement disorders following electrical injury are limited. While the pathophysiology of peripherally induced movement disorders remains poorly understood, reorganization of central pathways in response to injury is presumed. Here, we describe a case of electrocution causing focal epilepsy and limb analgesia replaced 17 years later by hyperalgesia, vasomotor disturbance, and non-epileptic involuntary movements.

Method: Clinical presentation and follow-up are described.

Results: A 32-year-old male sustained a 440-volt electrocution to the left arm. As he recovered from the acute injury, left arm pain and numbness evolved into left hemi-body paresthesias. Exam revealed left hemihypesthesia to pinprick. EMG and head MRI were normal. One month later he developed frequent episodes of left sided dystonic spasms and later convulsive seizures, which were controlled with antiepileptics. 17 years later, he discontinued seizure medications due to side effects. Within a few months, for the first time since the injury, sensation gradually returned to the arm. However, it came with disabling pain, episodic limb swelling with discoloration, and decreased dexterity suggestive of CRPS. Tremor-like movements of left hand and irregular jerks of the arm accompanied pain exacerbations. Musculoskeletal and vascular imaging of the arm as well as EEG, EMG, and MRI brain and C-spine were normal. On exam, rapid alternating movements were effortful and triggered a pain exacerbation associated with subtle edema and flushing as well as irregular, high frequency, low amplitude tremulous movements. Treatment with pregabalin and a multidisciplinary team including pain medicine, occupational and cognitive-behavioral therapy have improved limb function, but significant disability persists.

Conclusion: This complex case of post-electrocution movement disorder demonstrates the interplay of the central and peripheral nervous systems in sensory perception and movement. It reminds us that many of our patients’ symptoms and experiences are inadequately explained by our current understanding of pathophysiology.

« Back to 2022 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/painful-arm-spasms-after-remote-electrical-injury-focal-epilepsy-begets-causalgia-dystonia/