Benign Neonatal Sleep Myoclonus

Benign Neonatal Sleep Myoclonus On Dickens, and Pediatrics Sir.\p=m-\Wewould like to report an additional case of benign neonatal sleep myoclonus1 recently seen when the patient was 5 days of age. On day 3 the child developed the typical features of jerking when asleep; this lasted a few seconds with no associated features. Results of examination that included electroencephalogram when the patient was awake were normal, and no abnormality appeared on biochemical, hematologic, or infection screens. Of interest was the presence of pronounced stimulus-induced myoclonus when the patient was asleep. He was being nursed in a clear cot; when the cot was tapped, several myoclonic jerks were evident in the arms. These did not disappear with holding of the limbs. Recent pediatric neurology text- books2,3 have referred to this condition as benign neonatal myoclonus, but the paucity of information in these sources demonstrates the difficulty of keeping up with the broad expanse of knowledge in our field. The presence of stimulusinduced myoclonus during sleep in the early stages of the condition may be an additional marker in its clinical spectrum. LINDSAY J. SMITH, FRACP NEIL H. THOMAS, MRCP Newcomen Center Guy's Hospital London SEI 9RT England Daoust-Roy J, Seshia SS. Benign neonatal sleep myoclonus. AJDC. 1992;146:1236\x=req-\ 1. 1241. 2. Aicardi J. Disease of the Nervous System in Childhood. London, England: MacKeith Press; 1992:1013. 3. Brett E. Paediatric Neurology. New NY: Churchill Livingstone Inc; 1991:323. Tiny Tim, Charles York, Sir.\p=m-\Usingretrospective diagnosis, Lewis,1 in the December 1992 issue of AJDC, hypothesizes a case of distal renal tubule acidosis (RTA) (type 1) in Charles Dickens' beloved literary character, Tiny Tim,2 and provides excellent documentation of how London's working poor lived and the types of medical treatments and measures available in the 1840s. However, there are three critical points on Dickens and medicine that Lewis should consider beyond the case of Tiny Tim that would better substantiate the British novelist, rather than a 20th-century commentator, as an astute and accurate medical observer. The first point is to recall that Dickens was fascinated with all aspects of humanity, including the propensity to illness. A strong supporter of public health, medical, and sanitation reforms, Dickens was a frequent visitor to hospitals and helped raise large amounts of money for London's Great Ormond Street Hospital for Children, the London Foundling Hospital, and the Boston Children's Hospital. Dickens was also friendly with numerous prominent London physi¬ cians, including T. Southwood Smith and Sir Thomas S. Watson, and fre¬ quently consulted with them, not only about his own health but about spe¬ cific medical and psychological con¬ ditions he wished to attribute to his literary characters.3,4 Second, literary and medical histo¬ rians have documented on several oc¬ casions that Dickens produced accu¬ rate descriptions of disease, both med¬ ical and psychological, based on real disorders as opposed to invented mal¬ adies with inconsistent symptom sets, which was a common practice among most of Dickens' contemporary Vic¬ torian novelists, such as Anthony Trol- Downloaded From: http://archpedi.jamanetwork.com/ by a New York University User on 05/19/2015 lope or William Thackeray. Conditions ranging from smallpox to closed-head trauma to the well-known Pickwick¬ ian syndrome, named for a minor char¬ acter in The Pickwick Papers, have been brilliantly portrayed by Dickens in many of his characters.5"8 Indeed, some of these conditions were described by Dickens before the physicians got around to them. Finally, when one considers Dick¬ ens' avid interest in recording the plights of abandoned or orphaned chil¬ dren in his novels, which may have been inspired by his own troubled childhood; his attraction to all elements of the human condition, both normal and abnormal; and his charitable work for children's hospitals, one is not sur¬ prised to find that he was fascinated with the diseases these unfortunate individuals developed within the con¬ text of his fictional world.9,10 But Lewis' conclusions are not to be considered glaring errors and, instead, give us still another Christmas gift, albeit belated; the opportunity to dis¬ cuss again the diagnostic skills of Charles Dickens. As the obituarist for the British Medical Journal" lamented at Dickens' passing in 1870: "What a gain it would have been to physic if so keen to observe and so facile to de¬ scribe had devoted his powers to the medical art." HOWARD MARKEL, MD Institute of the History of Medicine The Johns Hopkins University 1900 E Monument St Baltimore, MD 21205 1. Lewis DW. What was wrong with AJDC. 1992;146:1403-1407. Tiny Tim? 2. Dickens C. A Christmas Carol. London, Enand Hall; 1843. 3. Markel H. Charles Dickens and the art of medicine. Ann Intern Med. 1984;101:408-411. 4. Poynter FNL. Thomas Southwood Smith: the man, 1788-1861. Proc R Soc Med. 1962;55: 381-392. 5. Gurney MS. Disease as device: the role of smallpox in Bleak House. Lit Med. 1990;9:79-92. gland: Chapman