DOI: 10.1055/a-2338-5736
Videos and Images in Neuropediatrics

Reversal of Benzodiazepine-Induced Myoclonus by Flumazenil in the Neonatal Intensive Care Unit

Gianluca D'Onofrio
1   Department of Neurosciences Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
2   Division of Pediatric Neurology, Department of Neurosciences, CHU Sainte-Justine, University of Montréal, Québec, Canada
Philippe Major
2   Division of Pediatric Neurology, Department of Neurosciences, CHU Sainte-Justine, University of Montréal, Québec, Canada
› Author Affiliations

This is a late preterm, 36 1/7 gestational weeks, admitted to the neonatal intensive care unit for severe renal dysplasia secondary to obstructive uropathy, and pulmonary hypoplasia complicated with pulmonary hypertension. On the 12th day of life, sedation with lorazepam 0.1 mg/kg was administered in preparation for an invasive procedure. The baby immediately started to experience generalized myoclonus ([Video 1—Part A]). On suspicion of an epileptic origin, phenobarbital 20 mg/kg was administered, with no success. Cranial ultrasound revealed no bleeding, while electroencephalography showed no epileptiform discharges ([Fig. 1]). Suspecting benzodiazepine-induced myoclonus, flumazenil at 0.01 mg/kg was administered, resulting in cessation of movements in around 15 minutes ([Video 1—Part B]). Myoclonus has been reported in neonates after benzodiazepine administration.[1] [2] [3] This phenomenon seems to stem from the developmental activity of the GABA receptor, potentially heightening the vulnerability of preterm infants.[2] The cessation of movements after flumazenil has been documented in just two other cases.[1] [2] Our case provides videographic documentation, enhancing understanding of benzodiazepine-induced myoclonus in neonates.

Video 1 In the first part, generalized myoclonias are observed following the administration of lorazepam. The second part shows cessation of abnormal movements following administration of flumazenil.

Zoom Image
Fig. 1 EEG showed no epileptiform discharges concurrent with the myoclonus. EEG, electroencephalography.

Author Contributions

Study conception and design: G.D'O., P.M.; data collection, analysis, and interpretation of results: G.D'O.; draft manuscript preparation: G.D'O. All authors reviewed the results and approved the final version of the manuscript.

Publication History

Received: 09 May 2024

Accepted: 03 June 2024

Accepted Manuscript online:
05 June 2024

Article published online:
02 July 2024

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  • References

  • 1 Zaw W, Knoppert DC, da Silva O. Flumazenil's reversal of myoclonic-like movements associated with midazolam in term newborns. Pharmacotherapy 2001; 21 (05) 642-646
  • 2 Ozcan B, Kavurt S, Yucel H, Bas AY, Demirel N. Rhythmic myoclonic jerking induced by midazolam in a preterm infant. Pediatr Neurol 2015; 52 (06) e9
  • 3 Magny JF, d'Allest AM, Nedelcoux H, Zupan V, Dehan M. Midazolam and myoclonus in neonate. Eur J Pediatr 1994; 153 (05) 389-390