Spinal cord stimulation for idiopathic spinal myoclonus: illustrative case

BACKGROUND: Spinal myoclonus is a rare movement disorder characterized by sudden, involuntary jerking movements arising from segmental spinal circuitry. Treatment is primarily directed toward underlying etiologies or symptomatic control with antiepileptic medications, botulinum toxin injections, or intrathecal therapies. Evidence supporting spinal cord stimulation (SCS) remains limited to isolated reports involving secondary etiologies such as cervical myelopathy or complex regional pain syndrome. The role of SCS in idiopathic segmental spinal myoclonus remains poorly defined. OBSERVATIONS: An 83-year-old woman with medically refractory segmental spinal myoclonus involving the right paraspinal musculature, shoulder girdle, and upper back experienced near-complete resolution of symptoms following thoracic SCS after unsuccessful treatment with multiple medications and botulinum toxin injections. Permanent implantation resulted in sustained symptomatic improvement with complete resolution of jerks at the 7-month follow-up. LESSONS: SCS may represent a promising neuromodulatory strategy for patients with idiopathic segmental spinal myoclonus refractory to conventional therapy. This case expands the limited literature supporting the use of SCS in spinal myoclonus and suggests a potential role for dorsal column neuromodulation even in the absence of structural spinal pathology. https://thejns.org/doi/10.3171/CASE26322.