Benign Neonatal Sleep Myoclonus Treatment & Management

Updated: Dec 17, 2019
  • Author: Marc P DiFazio, MD; Chief Editor: Ted Rosenkrantz, MD  more...
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Treatment

Medical Care

Medical care of benign neonatal sleep myoclonus (BNSM) consists of making a timely diagnosis. Delayed recognition often results in extensive diagnostic testing, including screening for infectious causes of seizures (eg, spinal tap, blood cultures, empiric antibiotics) and neurodiagnostics (eg, electroencephalography, brain imaging, brain monitoring). This process almost invariably results in admission to the hospital and a great deal of family distress.

Early recognition of BNSM can be facilitated by the use of home-video monitoring by parents, especially if the episodes are frequent. If the child is otherwise clinically well, ask the parents to obtain video footage while their child undergoes medical evaluation. Once a provider is experienced in the clinical manifestations, this can be invaluable in the diagnosis of benign neonatal sleep myoclonus. At that point, parents are reassured regarding the benign nature of the condition and educated regarding the prognosis. If clinical concern for possible seizure remains but the child is otherwise clinically stable (eg, without concerning pregnancy-related risk factors or abnormal findings on examination), admission to the hospital for a short stay to facilitate monitoring and observation by trained professionals is prudent.

Inpatient care is warranted in patients with BNSM only if other risk factors for neurologic disease are evident, such as developmental concerns, deficits or abnormalities upon examination, or signs of metabolic or infectious disease. However, as mentioned above, inpatient care should be strongly considered if the movements have not been clearly identified as benign in nature by a medical provider.

No medication is necessary in benign neonatal sleep myoclonus. In fact, treatment with benzodiazepines and other anticonvulsants may worsen the movements because they may cause sedation and sleep.

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Consultations

If clinical confusion remains, a pediatric neurologist should be consulted to observe video footage and to perform an extended neurologic examination. Further diagnostic testing could be ordered based on their assessment and based on concern regarding possible seizures or other more ominous causes of myoclonus in children. This would be especially pertinent in patients with late-onset manifestations or with other concerning neurologic findings.

If clinical concern remains regarding the diagnosis, transfer the patient to a location where further neurodiagnostic testing and expertise can support the evaluation.

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Long-Term Monitoring

Outpatient care of the child with a clear history of benign neonatal sleep myoclonus is within the purview of a general pediatrician. Monitoring for other neurologic or developmental concerns is included in the standard recommendations for pediatric care in the first year of life.

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