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JAMA Neurology Clinical Challenge
April 1, 2019

Recurrent Involuntary Contractions of the Face, Arm, and Leg in an Elderly Man

Author Affiliations
  • 1Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
JAMA Neurol. 2019;76(6):728-731. doi:10.1001/jamaneurol.2019.0452

A man in his 60s was evaluated in the epilepsy monitoring unit for various spells he had been having up to 5 times a day over the previous 8 months. He described transient episodes of expressive speech difficulties, paroxysmal dizziness, and involuntary nonsuppressible jerks of the right arm, which occurred without warning and were associated with mild disorientation. Video electroencephalography (EEG) captured the movements (Figure, A). They consisted of involuntary, synchronous contractions of the right face, arm, and leg that were sustained for a few seconds before muscle relaxation occurred (Figure, B and C; Video). The movements were not elicited by action or exertion. There was no epileptic abnormality that correlated with the movements on EEG, and head magnetic resonance imaging was unremarkable.