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Neurological Rehabilitation

Spasticity and Diffuse Clonus in Acute Disseminated Encephalomyelitis: A Case Report

Thursday, October 23, 2025
12:45 PM - 2:15 PM MT
Location: Kiosk 5

    Poster Presenter(s)

  • Jennifer Hegedus, DO

    Resident Physician
    Burke Rehabilitation Hospital PM&R Program
    New Rochelle, New York

    • Co-Author(s)

  • Matthew Slitzky, DO

    Resident
    Burke Rehabilitation Hospital PM&R Program
    White Plains, New York

  • PK

    Preetveer Kaur, DO

    Resident physician
    Burke Rehabilitation Hospital PM&R Program
    White Plains, New York

  • Bryan Le, MD

    Assistant Professor
    Montefiore Medical Center
    New York, New York

Disclosure(s):
Jennifer Hegedus, DO: No financial relationships to disclose
Matthew Slitzky, DO: No financial relationships to disclose
Bryan Le, MD: No relevant disclosure to display
Case Diagnosis: A 36 year old male with acute disseminated encephalomyelitis experiencing diffuse clonus and spasticity.

Case Description or Program Description: A 36-year-old male with a history of post-viral encephalomyelitis complicated by paraplegia presented to the outpatient clinic due to severe lower extremity spasticity. He was managing his spasticity with 40mg of baclofen 3 times daily; however, he continued to have pain and episodes of diffuse spastic lower extremity clonus with light touch and passive range of motion to his lower extremities.

Setting: Outpatient academic clinic

Assessment/Results: Patient previously trialed a baclofen pump with moderate relief, but decided to defer due to concerns regarding receiving an implanted device. On exam, he had 0/5 strength in both lower extremities, and with manipulation, had diffuse sustained bilateral lower extremity clonus. Due to the diffuse nature of his spasticity, he was not a candidate for antispasmodic injections.

Discussion (relevance): Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disorder of the central nervous system more commonly seen in childhood, thought to be an immune-mediated condition of parainfectious origin. It is clinically characterized by the acute onset of focal neurological deficits such as paraplegia, cranial nerve abnormalities, brainstem dysfunction, and encephalopathy. Spasticity in ADEM can be attributed to demyelinating lesions affecting the corticospinal tract. Damage to these tracts disrupts normal motor pathways, leading to increased excitability of spinal reflexes and subsequent muscle spasticity. The prevalence of spasticity in ADEM in adults is not well-documented or standardized compared to other demyelinating diseases. A systematic review of ADEM in adults found that 68.7% of patients had variations of pyramidal signs at presentation. In our patient, spasticity was a significant barrier to greater function.

Conclusions: Spasticity in ADEM has a significant impact on functional outcomes and quality of life. Further research is needed to explore optimal management strategies for spasticity in ADEM to improve patient care and recovery rates.