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Neurological Rehabilitation

Amantadine-Induced Myoclonus: A Rare Manifestation in the Treatment of Hypoarousal in Post-Stroke Recovery- A Case Report

Thursday, October 23, 2025
5:00 PM - 6:30 PM MT
Location: Open Kiosks

    Primary Author(s)

  • Bilal M. Ali, MD

    Resident Physician
    Detroit Medical Center/Wayne State University PM&R Program
    Auburn Hills, Michigan

    • Poster Presenter(s)

  • NP

    Nicholas Polakowski, MD

    Resident
    Detroit Medical Center/Wayne State University PM&R Program
    Royal Oak, Michigan

    • Co-Author(s)

  • AA

    Alaa Abu-Mahfouz, MD

    PM&R Resident
    Detroit Medical Center/Wayne State University PM&R Program
    Detroit, Michigan

  • AR

    Amanda Reyes, MD

    Resident physician
    Detroit Medical Center/Wayne State University PM&R Program
    Sterling Heights, Michigan

  • MA

    Michael Ajluni, MD

    Residency Program Director
    Detroit Medical Center/Wayne State University PM&R Program
    Northville, Michigan

Disclosure(s):
Bilal M. Ali, MD: No financial relationships to disclose
Michael Ajluni, MD: No financial relationships to disclose
Case Diagnosis: We discuss the case of a patient admitted to inpatient rehab following a pontine stroke who was started on Amantadine due to hypoarousal, and developed myoclonic jerks that resolved after Amantadine was discontinued.

Case Description or Program Description: A 42-year-old male with a history of uncontrolled hypertension was admitted to inpatient rehab following medical stabilization for a pontine parenchymal hematoma with extension into the fourth ventricle. Hospital course was complicated by ventilator-dependent respiratory failure and pneumonia thus necessitating tracheostomy and PEG placement. Due to persistent hypoarousal in inpatient rehab, amantadine was initiated and titrated to 150 mg twice daily. Patient experienced worsening mentation and multiple episodes of repetitive, involuntary jerking movements in the left upper and lower extremities, suggestive of seizure-like activity or myoclonic jerks.

Setting: Inpatient Rehab Stroke Recovery Unit

Assessment/Results: Seizure workup was completed, including neuroimaging and electroencephalogram (EEG). Head CT was unremarkable, and EEG showed no epileptiform activity. An in depth chart review was conducted and it was determined that the patient’s myoclonic activity coincided with the uptitration of amantadine. Upon discontinuation of amantadine, the patient’s myoclonic jerks resolved completely and mentation rapidly improved. There was no recurrence of his symptoms.

Discussion (relevance): Amantadine is one of the first line agents used in the treatment of hypoarousal in stroke patients. It is imperative to consider the side effects of Amantadine. This case highlights the importance of monitoring patients when adjusting medications, as rare side effects may manifest as acute pathology.

Conclusions: Myoclonic jerking is a rare side effect clinicians should be aware of when prescribing Amantadine. Discontinuing this medication can allow for quick correction of side effects and avoid unnecessary workup.