Generalized myoclonus restricted to the “Smack” withdrawal state: A rare case report

Abstract

Myoclonus is regarded as a direct neurotoxic effect of opioid metabolites. It is seen less frequently in conjunction with opioid discontinuation (opioid withdrawal myoclonus [OWM]). Only a few case reports from palliative medicine and anesthesia have highlighted the development of OWM. We report an unusual case of a 35 years old, opioid-dependent (smack) adult male who developed abnormal involuntary jerky movements of limbs and torso in the withdrawal phase. There was no change in the level of consciousness. The neurological examination as well as serum biochemistry was normal. The electroencephalogram showed no epileptiform activity. The patient was started on oral substitution therapy (tramadol 150 mg/day) after which abnormal movements subsided within 72 h. We conclude that myoclonus can be a part of opioid withdrawal. Appropriate recognition of its benign nature and psycho-education to patients and families shall foresee better outcomes.