Antibiotics induced lactase deficiency as cause for abdominal involuntary movements

A rare condition is temporary but recurrent onset of involuntary motion sequences in the abdominal region. They demands for an extensive diagnostic workup. Therapeutic options are limited. The successful treatment of this spinal myoclonus or abdominal involuntary movements resembling syndrome prompted this report. At admission, the 52 years old female patient reported onset of “Abdominal Convulsions” for four months. She reported that initially she was diagnosed with a Helicobacter pylori infection after complaining a gastrointestinal pain syndrome. Then antibiotic therapy with amoxicillin and clarithromycin was started in combination with the proton pump inhibitor omeprazole. On the second day of this treatment regime, she developed recurrent onset of diarrhea and initial temporary spinal myoclonus in the abdominal region. Since that time she also experienced transient “Attacks” with sudden onset of agitation, drowsiness, sweaty and tremulous hands. Following neurologic consultation, a supplementary antidepressant therapy with initially 30 mg mirtazapine and then 10 mg escitalopram was additionally started. Three months later, routine control showed persistent Helicobacter pylori infection. Again, she received the same antibiotic therapy regimen. Now abdominal involuntary motions were present during the whole day and mostly during sleep. The patient was desperate, took occasionally the benzodiazepine lorazepam in daily dosages up to 4 mg and was worried about considerable limitations of quality of life. In out department.