Myoclonic status epilepticus in the setting of renal failure

This 65-year-old man had a history of bilateral kidney transplants complicated by autoimmune rejection. He presented on two occasions with obtunded mental status and frequent myoclonic jerks lasting more than 24 hours in the setting of acute or chronic renal failure. On exam, the patient had both synchronous and asynchronous myoclonic jerks predominantly affecting the upper extremities. Movement artifact in the EKG lead corresponds to myoclonic jerks of right shoulder (black arrow), left arm and shoulder (red arrows), torso (green arrow) and head (blue arrow). Some of the myoclonic jerks immediately follow a central sharp wave (first three arrows), but others do not have a clear EEG correlate (second three arrows). The patient’s myoclonus and mental status improved following dialysis. (Reproduced with kind permission of Springer Science+Business Media: Gerard E, Hirsch L. Generalised myoclonic status epilepticus. In: Panayiotopoulos CP, editor. The Atlas of Epilepsies. Springer, 2010.)