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Letter to the editor
 Re: Comments on “Chorea as a Presentation of SARS-CoV-2 Encephalitis: A Clinical Case Report”
Muhammad Hassanorcid, Naveed Ullah Khanorcid, Mazhar Badshahorcid
Journal of Movement Disorders 2022;15(1):94-94.
DOI: https://doi.org/10.14802/jmd.21111
Published online: December 7, 2021
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Department of Neurology, Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU), Islamabad, Pakistan

Corresponding author: Muhammad Hassan, MD Department of Neurology, Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU), Islamabad, Pakistan / Tel: +92-3335853640 / E-mail: drhassaanshafqat2011@gmail.com
• Received: August 3, 2021   • Revised: September 9, 2021   • Accepted: September 14, 2021

Copyright © 2022 The Korean Movement Disorder Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Dear Editor,
The accurate differential diagnosis between myoclonus and chorea by neurological examination without electrophysiological studies is occasionally difficult, since not only myoclonus but also chorea may present irregular jerky movements. Myoclonus is defined as a sudden, brief, lightning-like muscle contraction. Furthermore, myoclonus includes both muscular contraction phenomenology (positive myoclonus) and inhibition of muscular contraction phenomenology (negative myoclonus) [1]. There are various etiologies and pathogenesis of myoclonus, most often categorized into cortical, subcortical, or spinal myoclonus. However, the pathophysiology of chorea is mainly implicated in dysfunction of the basal ganglia motor circuitry.
The first video of the patient showed abnormal movements that were involuntary, abrupt, nonstereotyped, irregular, sometimes large-amplitude, and unpredictable on the right leg and arm, defined as chorea by the authors [2]. However, as pointed out in the letter [3], myoclonus was also observed in the first video, and all abnormal movements in the other videos appear to be myoclonus [2]. Therefore, the patient may have a combination of abnormal movements due to both myoclonus and chorea.

Ethical Standard

Not applicable.

Conflicts of Interest

The authors have no financial conflicts of interest.

Funding Statement

None.

Author Contributions

Conceptualization: Muhammad Hassan. Data curation: Muhammad Hassan. Investigation: Naveed Ullah Khan. Methodology: Mazhar Badshah. Software: Naveed Ullah Khan. Supervision: Mazhar Badshah. Writing—original draft: Naveed Ullah Khan. Writing—review & editing: Mazhar Badshah, Muhammad Hassan.

  • 1. Marsden CD, Hallett M, Fahn S. The nosology and pathophysiology of myoclonus. In: Marsden CD, Fahn S, editors. Movement Disorders. London: Butterworths; 1982:196–248.
  • 2. Hassan M, Syed F, Ali L, Rajput HM, Faisal F, Shahzad W, et al. Chorea as a presentation of SARS-CoV-2 encephalitis: a clinical case report. J Mov Disord 2021;14:245–247.ArticlePubMedPMC
  • 3. Walker RH. Comment on “Chorea as a Presentation of SARS-CoV-2 Encephalitis: A Clinical Case Report”. J Mov Disord 2021;Dec. 7. [Epub]. Available from: https://doi.org/10.14802/jmd.21068. Article

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