As Myoclonus are called involuntary muscle twitches. Only from a certain degree of severity and in a symptomatic connection with neurological diseases do myoclonus have a clinical disease value. The treatment of the patient depends on the causal disease.
What is myoclonus?
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Myoclonia is not actually a disease itself, but is classified as an accompanying symptom of various neurological diseases. Since they can be symptomatic of numerous diseases, they are relatively unspecific accompanying symptoms. Patients with myoclonia experience involuntary contractions or twitching of a muscle or group of muscles.
The uncontrolled movements can have cortical origins in the cerebral cortex, subcortical origins in other brain regions, or spinal origins in the spinal cord. The symptom is attributed to the extrapyramidal hyperkinesias. This is a group of movement disorders that are based on malfunctions of the basal ganglia in the extrapyramidal motor system. Not all myoclonus have disease value.
Physiologically, myoclonus occurs in the form of twitching asleep, as the muscles relax. Myoclonus after overloading the muscles are also not pathological. The twitches can be rhythmic or arrhythmic and have different intensity of movement. The muscles of the extremities near the trunk are most frequently affected.
With voluntary movements at the same time as the myoclonus, we speak of an action myoclonus. If the twitches can be traced back to external stimuli such as light stimuli, medicine speaks of a reflex myoclonus.
causes
Natural myoclonus without any disease value can occur both in the falling asleep phase as well as after stronger muscle loads and signal the relaxation phase of the muscles. Myoclonus with pathological value can be caused by various neurological diseases. They occur most frequently in the context of epilepsy, for example in juvenile myoclonic epilepsy or progressive myoclonus epilepsy.
Non-epileptic diseases can also be accompanied by myoclonus. Unlike the epileptic variant, the myoclonus of other diseases can be influenced by irritation. Syncope shows myoclonia as a symptom. Simple tics, neurodegenerative diseases and shudder attacks can also be accompanied by myoclonus.
Some myoclonus are caused by cortical damage, such as those in Creutzfeldt-Jakob disease, in metabolic, viral and toxic encephalopathies, in the acute posthypoxic or chronic posthypoxic myoclonus syndrome and in the anticholinergic syndrome, in Schwartz-Bartter syndrome or one acute intermittent porphyria may be present.
Many other diseases and trauma can cause spinal damage, which can also result in myoclonus. The abnormal change in muscle activity caused by abnormal brain or spinal nerve activity is considered to be a generalized cause.
Diseases with this symptom
- Creutzfeldt-Jakob disease
- Serotonin syndrome
- Schwartz-Bartter Syndrome
- trauma
- epilepsy
- Porphyria
Diagnosis & course
Myoclonia manifest themselves in the form of jerky, rhythmic or arrhythmic jerks of the muscles and can occur focally, multifocal and generalized. The contraction and subsequent relaxation of the affected muscles follow each other quickly. The exercise intensity varies between weak and strong degrees. The muscles of the extremities near the trunk are most frequently affected by the twitching.
Apart from that, patients can also complain of myoclonic facial expressions or trunk muscles. The twitches do not necessarily have to be associated with an impairment in everyday life. Depending on the primary cause, the affected patients usually suffer from additional symptoms. If cortical or spinal damage to the central nervous system is the cause of the twitching, several accompanying symptoms can occur.
In acute cases, these range from severe headaches to impaired movement and organic impairments with a highly variable range of symptoms. In the case of metabolic damage to the brain or the spinal cord, specific symptoms for the respective organ insufficiency can also occur, for example proteinuria in the case of causal kidney damage.
The doctor recognizes by visual diagnosis whether a patient is affected by myoclonus. As a rule, only myoclonia above a certain degree of severity are the reason for further examination and clarification of the primary cause. In most cases, the primary cause is already diagnosed before severe myoclonus occurs, such as renal insufficiency that has caused encephalopathy.
The doctor may use imaging methods such as MRI to more closely research the cause and determine the condition to depict the spine and the brain. The patient's prognosis depends on the primary disease that triggers it.
Complications
Myoclonus, or muscle twitching, occurs primarily during an epileptic seizure. This can last a few minutes, but in the worst case it can lead to status epilepticus that lasts for more than 20 minutes and is usually associated with unconsciousness of the person concerned. This is a medical emergency and should be treated immediately. The lethality of a status epilepticus is around ten percent.
Typical myoclonus can also occur in Creutzfeldt Jakob disease. In this disease, the brain is attacked by prions, which change it degeneratively. In addition, patients are more prone to urinary tract or respiratory infections. After a while, the brain is no longer able to control vital functions, so that the person concerned dies.
Furthermore, the 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 tiredness, confusion and even coma. Acute intermittent porphyria usually goes well, but it can also result in serious complications.
On the one hand, this can damage the kidney or liver, and it also leads to high blood pressure. Difficulty breathing, muscle weakness or changes in the skin can also 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 in itself, but a symptom of other ailments. These are neurological in nature and can even lead to epilepsy. Whether you need to see a doctor or even a specialist depends on the severity of the disease.
There is no urgent need to see a doctor for a simple muscle twitch. In this case, it is sufficient to tell the family doctor about the occurrence of myoclonia during the annual routine examination. An experienced family doctor can use a visual diagnosis to determine whether the disease behind the myoclonia needs treatment or not. From a certain degree of severity, at which the patient suffers seriously from the muscle cramps, a visit to a neurologist is mandatory. The disease can affect the face and cause twitching, which of course leads to incapacity for work. Even people in dangerous jobs cannot work if there are uncontrollable jerks of the entire musculature.
Myclonia is basically not life threatening to the patient. However, the symptoms of the disease can provide clues to a deeper-lying disease that can be dangerous. If you feel that you cannot control yourself at times, you should consult your family doctor.
Doctors & therapists in your area
Treatment & Therapy
Myoclonia is just a symptom of a major disease. Ultimately, without knowing the cause of a myoclonia, little can be said about the therapeutic steps indicated. Treatment usually focuses primarily on treating the underlying disease.
Myoclonia after spinal, cortical or other damage to the central nervous system usually cannot be treated causally. As soon as the damage has occurred, it can usually no longer be completely reversed. The symptom of myoclonus is therefore mainly addressed with supportive therapeutic steps. These supportive steps mainly include physiotherapy and occupational therapy.
In terms of physiotherapy, stroke patients, for example, have already managed to transfer the functions of a damaged brain area to an intact area. Such a transfer is possibly also conceivable in order to alleviate or even eliminate myoclonus. In the case of myoclonus caused by peripheral nerve damage, there is sometimes the possibility of complete regeneration of the affected nerve tissue.
Outlook & forecast
With myoclonia, in addition to the twitching of the muscles, there is a very severe headache. These can also cause dizziness and nausea, and thus seriously affect the patient's life. The twitches in the myoclonus itself do not necessarily have to lead to impairment of life.
In most cases, the disease also causes damage to organs and the spinal cord. The kidneys are particularly affected here. If myoclonus occurs after an epileptic seizure, it must be treated immediately. Myoclonia often leads to restrictions and inflammation of the airways. This leads to shortness of breath and weakened muscles.
The treatment of myoclonus depends primarily on the origin of the disease. Often the disease cannot be specifically treated. However, their symptoms can be reduced so that the patient can lead an ordinary life. If no organs are damaged in the course of myoclony, there is no reduction in life expectancy.
prevention
Mild myoclonia without any disease value affect almost all people. If you don't overload your muscles and also practice relaxation techniques before going to bed, you will hardly notice the twitching. Strong and pathologically relevant myoclonia can only be prevented insofar as the causal diseases can be prevented.
You can do that yourself
Severe myoclonus should always be treated by a specialist. In addition, patients can increase their chances of recovery through physiotherapy and occupational therapy. A comprehensive physiotherapeutic program, which is based on the degree of disability and the living conditions of the patient, is recommended, especially for stroke patients.
Mild muscle twitches can be reduced by relaxing, walking and exercising, among other things. If this occurs more frequently, various relaxation methods such as yoga or autogenic training can help to reduce the myoclonia. In addition, triggering stress factors should be minimized. It is possible that the myoclonus is also due to a simple magnesium deficiency, which can be countered with a diet rich in magnesium. The mineral is particularly rich in bananas, beans, broccoli and oat flakes.
To prevent future spasms, it is important to drink enough and to take small breaks from time to time. Furthermore, stretching exercises, a relaxing full bath and avoiding alcohol and caffeine help. The occurrence and intensity of the muscle twitching should be recorded with the help of an illness diary. Anyone who is affected by moderate or severe myoclonus should work out an adequate therapy together with their family doctor or chiropractor.
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