Myoclonus refers to involuntary muscle twitching. Only after a certain degree of severity and in a symptomatic context with neurological diseases myoclonus have a clinical disease value. The treatment of the patients depends on the causative disease.

What is myoclonus?

Natural myoclonus without disease can occur both during sleep as well as after stronger muscle load and signal the relaxation phase of the muscles. Myoclonia with pathological value can be caused by various neurological diseases.
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Myoclonus are not actually a disease themselves, but are classified as a concomitant symptom of various neurological diseases. Since they can be symptomatic of numerous diseases, they are relatively unspecific concomitant symptoms. Patients with myoclonus suffer from involuntary contractions or twitching of a muscle or muscle group.

The uncontrolled movements may have cortical origin in the cerebral cortex, subcortical origin in other brain regions or spinal origin in the spinal cord. The symptom is attributed to extrapyramidal hyperkinesias. This is a group of movement disorders that are due to dysfunction of the basal ganglia in the extrapyramidal motor system. Not all myoclonus have disease value.

So myoclonus occur physiologically in the form of sleep twitching, as the muscles relax. Even myoclonus after muscle overloads are not pathological. The twitches can be rhythmic or arrhythmic and have different intensity of movement. The fetal limb musculature is most frequently affected.

In voluntary movements simultaneously with the myoclonus there is talk of an action myoclonus. If the twitches are traceable to external stimuli such as light stimuli, the medicine speaks of a reflex myoclonus.

causes

Natural myoclonus without disease can occur both during sleep as well as after stronger muscle load and signal the relaxation phase of the muscles. Myoclonia with pathological value can be caused by various neurological diseases. They are most common in epilepsy, such as juvenile myoclonic epilepsy or progressive myoclonus epilepsy.

However, non-epileptic diseases may also be accompanied by myoclonus. Unlike the epileptic variant, the myoclonus of other diseases can be influenced by irritation. Syncope shows myoclonus as a symptom. Even simple tics, neurodegenerative diseases and shudder attacks may be accompanied by myoclonus.

Some myoclonus are attributed to cortical damage, such as in the context of Creutzfeldt-Jakob disease, in metabolic, viral and toxic encephalopathies in the context of acute posthypoxic or chronic posthypoxic myoclonus syndrome and the anticholinergic syndrome, in Schwartz-Bartter syndrome or a acute intermittent porphyria.

Many other diseases and traumas can cause spinal damage, which can also result in myoclonus. The abnormal change in muscle activity due to abnormal brain or spinal nerve activity is considered a generalized cause.

Diseases with this symptom

  • Creutzfeldt-Jakob disease
  • serotonin syndrome
  • Syndrome of inappropriate antidiuretic hormone secretion
  • trauma
  • epilepsy
  • porphyria

Diagnosis & History

Myoclonus manifest as jerky rhythmic or arrhythmic twitching of the musculature and can be focal, multifocal and generalized. The contraction and subsequent relaxation of the affected muscles follow each other rapidly. The intensity of movement varies between weak and strong degrees. Most commonly, the muscles of the trunk-proximal limb sections are affected by the convulsions.

Apart from that, patients can also complain of myoclonus of facial expressions or torso muscles. The convulsions do not necessarily have to be associated with an impairment in everyday life. Depending on the primary cause, affected patients usually suffer from other symptoms. If cortical or spinal damage to the central nervous system is the cause of the twitching, several concomitant symptoms may occur.

These range in the acute case of severe headaches to movement impairments and organic disorders with a highly variable range of symptoms. For metabolic damage to the brain or spinal cord, specific symptoms may also be present for the particular organ failure, such as proteinuria in the case of causative kidney damage.

The doctor recognizes by eye diagnosis whether a patient is affected by myoclonus. As a rule, only myoclonus above a certain level of severity give rise to further investigation and clarification of the primary cause. In most cases, the primary cause is already diagnosed before the onset of strong myoclonus, such as renal insufficiency, which has caused encephalopathy.

In some cases, the doctor uses imaging techniques such as MRI to study the spine and brain to further investigate and determine the condition. The prognosis of the patients depends on the triggering primary illness.

complications

A myoclonus, or muscle twitching, mainly occurs as part of an epileptic seizure. This can last a few minutes, but can also lead in the worst case in a status epilepticus, which lasts over 20 min and usually associated with an unconsciousness of the person concerned. This is a medical emergency and should be treated immediately. The lethality of a status epilepticus is about ten percent.

Creutzfeldt Jakob disease can also cause typical myoclonus. In this disease, the brain is affected by prions, which change this degeneratively. Additionally, patients are more susceptible to urinary tract or respiratory infections. After a while, the brain is no longer able to control vital functions so that the person dies.

Furthermore, Schwartz-Bartter syndrome, an increased release of ADH, also causes muscle twitching. As a result of ADH, there is a lower concentration of sodium in the blood, which can lead to fatigue, confusion and even coma. Acute intermittent porphyria usually progresses well, but may also result in serious complications.

On the one hand, this can damage the kidney or the liver, and it also causes hypertension. Even a shortness of breath, muscle weakness or changes in the skin can be complications of porphyria.

When should you go to the doctor?

Myoclonia manifests itself in involuntary and uncontrollable twitching of the muscles. The disease is basically not a disease of its own, but a symptom of other ailments. These are neurological in nature and may even lead to epilepsy. Whether to go to the doctor or even to a specialist, depends on the severity of the disease.

Because of a simple muscle twitching does not necessarily need to see a doctor. Here it is sufficient to tell the family doctor during the annual routine examination of the occurrence of myoclonus. An experienced family doctor can determine by eye diagnosis whether the disease behind the myoclonus is in need of treatment or not. From a certain severity, where the patient is seriously suffering from muscle cramps, a visit to a neurologist is mandatory. The disease can affect the face and cause twitching, which of course leads to disability. Even people in dangerous occupations can not work when uncontrollable twitching of the entire musculature occur.

Myclonia is basically not life threatening to the patient. However, the disease can provide evidence of a deeper disease, which can be quite dangerous. If you feel that you can not control yourself in phases, you should consult the family doctor.

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Treatment & Therapy

Myoclonus is merely the symptom of a major disease. Ultimately, little is known about the indicated treatment steps without knowing the cause of myoclonus. The treatment mostly focuses mainly on the therapy of the causative disease.

Myoclonus after spinal, cortical or elsewhere located damage to the central nervous system can not be treated causally as a rule. As soon as the damage has occurred, it can usually no longer be completely eliminated. The symptom of myoclonus is therefore addressed primarily with supportive therapy steps. These supportive steps include above all physiotherapy and occupational therapy.

Physiotherapeutically stroke patients, for example, have already managed to transfer the functions of a damaged brain area to an intact area. Such transmission may also be conceivable to alleviate or even eliminate myoclonus. In myoclonus with causal peripheral nerve damage, there is sometimes the possibility of a complete regeneration of the affected nerve tissue.

Outlook & Forecast

In myoclonus, in addition to the twitching of the muscles, there is a very severe headache. These can also cause dizziness and nausea and thus severely affect the patient's life. The convulsions in the myoclonia itself need not necessarily lead to an impairment of life.

In most cases, the disease also causes damage to the organs and the spinal cord. Here, especially the kidneys are affected. If the myoclonus occurs after an epileptic seizure, it must be treated immediately. Due to myoclonia, there are often restrictions and inflammation of the respiratory tract. As a result, there is shortness of breath and weakened muscles.

The treatment of myoclonia depends primarily on the origin of the disease. Often, the disease can not be treated specifically. However, their symptoms can be limited so that the patient can lead an ordinary life. If no organs are damaged in the course of myoclonus, there is no reduced life expectancy.

prevention

Mild myoclonus without disease affect nearly all people. Those who do not overload their muscles and also practice relaxation techniques before going to sleep will hardly notice the twitching. Strong and pathologically relevant myoclonus can be prevented only insofar as the causative diseases are to be prevented.

You can do that yourself

A pronounced myoclonia should always be treated by a specialist. Accompanying this, patients can increase their chances of healing through physiotherapy and occupational therapy. Especially for stroke patients, a comprehensive physiotherapy program is recommended, which depends on the degree of disability and the patient's living conditions.

Slight muscle twitches can be reduced, inter alia, by relaxation, walks and sports. With increased frequency, various relaxation methods such as yoga or autogenic training can help reduce myoclonus. In addition, triggering stress factors should be minimized. Perhaps the myoclonus is also based on a simple magnesium deficiency, which can be countered with a magnesium-rich diet. The mineral is especially rich in bananas, beans, broccoli or oatmeal.

To prevent future spasms, it is important to drink enough and to take small breaks again and again. Furthermore, stretching exercises, a relaxing full bath and the renunciation of alcohol and caffeine help. The occurrence and intensity of the muscle twitches should be recorded with the help of a disease diary. Those who are affected by medium-strength or strong myoclonus should work together with their family doctor or chiropractor to develop an adequate therapy.

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