A 60-Year-Old Man Is Brought to the Office Due to a 2-Week

A 60-year-old man is brought to the office due to a 2-week history of involuntary muscle spasms in his arms, especially when he is startled.  Over the past 2 months, the patient has experienced worsening insomnia and confusion and gotten lost in his surroundings.  He has no fever, headache, or urinary symptoms.  Temperature is 37.1 C (98.8 F) , blood pressure is 130/76 mm Hg, and pulse is 82/min.  The patient is alert but poorly groomed.  Examination is notable for frequent irregular jerks of the upper and lower extremities, increased muscle tone, brisk deep tendon reflexes, and bilateral extensor plantar responses.  On cognitive testing, the patient recalls 0 of 3 delayed recall items and is unable to draw a clock.  A noncontrast head CT scan is normal.  Electroencephalography reveals periodic sharp-wave complexes.  Which of the following is the most likely outcome for this patient?

A) Death within a year regardless of therapy
B) Rapid symptomatic improvement with pharmacotherapy
C) Rapid symptomatic improvement with surgery
D) Slow symptomatic progression despite pharmacotherapy
E) Slow symptomatic resolution with pharmacotherapy

Correct Answer:

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