Poster 16: Post-Anoxic Facial Myoclonus Triggered by Speaking but Not Singing: A Case Report

depression with only 68%, 58%, and 44% of patients havingserious complaints, respectively. Diminished participation inroutine activities of daily living was common; however, mostpatients (85%) described deficits in the mild to moderate rangeof severity. Pre- to post-treatment analyses found significantdifferences for PTSD (t � 4.2, df � 22) and life satisfaction (t �-4.0, df � 22) using paired two-tailed t-tests (P � .001).Conclusions: A civilian rehabilitation program specializ-ing in outpatient treatment of TBI and polytrauma maysupplement currently available military healthcare options.Further evaluation of patients’ post-injury recovery, continu-ing treatment and support needs, and access to relevantrehabilitation services appears warranted.Keywords: Rehabilitation, Traumatic brain injury, PTSD,Post-concussive syndrome.

Poster 16

Post-Anoxic Facial Myoclonus Triggered bySpeaking but Not Singing: A Case Report.Margaret M. Donlon, MD, MPH (UMDNJ, Newark,NJ); Jonathan L. Fellus, MD.

Disclosures: M. M. Donlon, None.Patients or Programs: A 28-year-old man collapsedwhile singing during a church event. After 15 minutes ofresuscitation, he regained a pulse but had already sufferedfrom severe anoxic brain injury. He was later diagnosed withcardiomyopathy and a defibrillator was implanted. Initiallyin a vegetative state, he progressively regained consciousnessduring inpatient rehabilitation and began to verbalize. How-ever, as he regained his ability to communicate, he alsodeveloped severe post-anoxic myoclonus in his facial mus-cles which was triggered by speaking and made intelligiblecommunication with the patient nearly impossible.Program Description: Several different medications failedto control the facial myoclonus. Levetiracetam had the mostnotable improvement, but only at higher doses which alsoinduced somnolence. As the patient’s level of consciousnessimproved and his attempts at verbal communication increased,the language-induced myoclonus became a frustrating barrier toachieving meaningful interaction with the patient.Setting: Inpatient brain injury unit at an acute rehabilita-tion facility.Results: During evening rounds, the patient was observedto be singing church hymns with his wife. While singing, thepatient did not exhibit any facial myoclonus, allowing him toenunciate clearly. However, the myoclonus re-appearedwhen he attempted to respond to questions.Discussion: Post-anoxic myoclonus is often poorly con-trolled with medications. While spoken language is known totrigger facial myoclonus, this is the first reported case whereits suppression was induced by singing. These findings sug-gest that different neural pathways are activated during facialmyoclonus. The cognitive process underlying vocal expres-sion appears to trigger myoclonus more than singing, whichis considered to be a more “automatic” function of the brain.Conclusions: Post-anoxic facial myoclonus can be in-

duced by speaking in brain-injured patients and is difficult tocontrol with medications. Automatic functions of the brain,such as singing or counting, may not trigger myoclonus to thesame extent. These strategies should be used in speech ther-apy with these patients, and may allow for improved com-munication with them.Keywords: Rehabilitation, Brain injury, Facial myoclonus,communication.

Poster 17

The Correlation Between Neuron-SpecificEnolase and Functional Outcomes inTraumatic Brain Injury.In-Sung Choi, MD, PhD (Chonnam National Uni-versity Hospital, Gwang-Ju, Korea, South); Ren-XiuBian; Jae-Young Han, MD; In-Gyu Kim; Min-KyungLee; Sam-Gyu Lee, MD, PhD.

Disclosures: I. Choi, None.Objective: To investigate the correlation between the se-rum neuron-specific enolase (NSE) level and severity of braininjury at onset and the correlation between the serum NSElevel and the functional outcomes in traumatic brain injury(TBI) patients.Design: Prospective case study.Setting: Tertiary-based hospital in Republic of Korea.Participants: Twenty-three acute TBI patients (17 men, 6women; age 53.3 � 17.2 years; initial Glasgow Coma Scale[GCS] score 8.7�3.3; 6 intracerebral hemorrhage, 8 sub-dural hemorrhage, 3 epidural hemorrhage, 7 intraventricularor subarachnoid hemorrhage, 3 diffuse axonal injury, per-mitting the overlapping count) were recruited.Interventions: Not applicable.Main Outcome Measures: The serum NSE level wasmeasured within 24 hours after brain injury. The severity ofbrain injury was measured by GCS at lowest point afterresuscitation. Functional outcomes were measured by Glas-gow Outcome Scale (GOS), Rancho Los Amigos level ofcognitive function (RLA) and Disability Rating Scales (DRS)at 6th week after the onset. Neurocognitive function wasmeasured by Mini-Mental Status Examination (MMSE) andLoewenstein Occupational Therapy Cognitive Assessment(LOTCA) at 6th week after the onset.Results: There was an inverse correlation between the se-rum NSE level and initial GCS (r � -0.496, P � .016). Theserum NSE level was significantly correlated with GOS andDRS score, respectively (r � 0.644, P � .010, r � 0.568, P �.027). The serum NSE level was inversely correlated withRLA and MMSE score, respectively (r � -0.577, P � .024,r � -0.603, P � .017). The serum NSE level was not signif-icantly correlated with LOTCA score (P � .05).Conclusions: The high serum NSE level correlated withpoor functional outcome in TBI patients, and the serum NSElevel would be useful in predicting the functional outcome inTBI patients.Keywords: Rehabilitation, Function, Outcome, Brain injury.

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