Disclosures: Harsha Ayyala, MD: Nothing to disclose

Case Description: A 30-year old male with history of multiple prior strokes and resolved left-sided hemiparesis, sickle cell trait, and syphilis who was recently diagnosed with HIV neuropathy presented with myoclonic jerks and sensory ataxia to Acute Rehabilitation. His syphilis diagnosis was confirmed in 2010 and he had a stable RPR test according to the health department given prior treatment. His HIV diagnosis was also confirmed although the patient had not received prior HAART therapy and recent CD4 cell count was 2, HIV viral load 42,500. MRI brain showed mild generalized volume loss with no intracranial abnormalities.

Setting: Acute Rehabilitation Facility

Patient: A 30-year old male with history of multiple prior strokes and resolved left-sided hemiparesis, sickle cell trait, and syphilis who was recently diagnosed with HIV neuropathy presented with myoclonic jerks and sensory ataxia to Acute Rehabilitation.

Assessment/Results: Prior to treatment, the patient was unable to perform certain activities such as bathing, grooming, dressing upper/lower body, toileting, toilet/tub transfers due to involuntary movements. Given his myoclonic jerks and ataxic gait, oral baclofen 5 mg three times daily was introduced a week into admission with clinical improvement. He noticeably demonstrated improved balance and coordination. On discharge, his ability to perform these activities progressed to modified independence in accordance with FIM scores during therapy.

Discussion: The addition of baclofen the patient’s treatment regimen translated to significant clinical improvement. While prior studies have examined movement disorders in HIV patients such as myoclonus due to subcortical mechanisms, symptoms have been shown to resolve with appropriate antiviral treatment, clonazepam, or anti-epileptic medications. In addition, prior studies have shown clinical success with the use of baclofen in other types of ataxia such as cerebellar ataxia.

Conclusion: This case study demonstrated that neurologic sequelae from untreated HIV including impaired coordination and myoclonic ataxia can have clinical improvement with antispasmodic agents such as oral baclofen.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/the-use-of-oral-baclofen-in-a-patient-with-hiv-induced-myoclonic-ataxia-a-case-report/