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Cortical mechanisms mediating asterixis

We describe a patient with chronic renal failure who suffered multifocal action‐induced jerks. Electromyography (EMG) recorded the typical silence of asterixis. Back‐averaging the EEG activity preceding the EMG silent periods in the forearm showed a biphasic wave antedating the asterixis by 23 ms. Somatosensory evoked potentials (SEPs) after median nerve stimulation were pathologically enlarged on both hemispheres. Brain‐mapping of the biphasic wave preceding asterixis and the giant SEPs indicated a common origin in the sensorimotor cortex. This observation provides further documentation of a cortical origin for some types of asterixis in humans.