Muscle Hypotonia: Causes, Symptoms & Treatment

By muscle hypotonia, the medical profession understands too little muscle tension with simultaneous weakness of the musculature, which is already noticeable in childhood. It always occurs as a symptom of an underlying disease and is treated with physiotherapeutic measures.

What is muscle hypotonia?

The term muscle hypotonia is composed of muscles and the Latin word “hypoton”, which means “reduced strength or tension” and is in itself a very accurate description of the symptoms. Affected individuals suffer from severely reduced strength, particularly in the striated muscles. This group of muscles includes cardiac and skeletal muscles, primarily the muscles of the body that are responsible for voluntary, actively controlled movements. Muscle hypotonia becomes noticeable because those affected move very little and have to exert themselves far beyond the normal level when making movements. In infancy, for example, parents notice the child’s abnormal effort when breastfeeding.

Causes

The causes of muscle hypotonia are varied, as it always occurs as a symptom of other underlying diseases, but never as a disease in its own right. As a rule, infants are already affected, and it is then referred to as infantile muscle hypotonia. The most frequent underlying diseases are metabolic disorders, the congenital neuromuscular disease nemalin myopathy and neurological diseases, alcohol embryopathy and various other congenital diseases. In the following, the most important ones will be briefly introduced. Alcohol embryopathy is a disorder that occurs as a result of significant alcohol consumption during pregnancy, usually in children born to alcohol-dependent mothers. Symptoms include decreased growth, mental retardation, behavioral abnormalities, and muscle hypotonia. Muscle hypotonia is also part of the symptoms in congenital trisomy 13 (Pätau syndrome), Edwards syndrome and Down syndrome. In rare cases, the first manifestation of muscle hypotonia occurs in advanced age, and autoimmune diseases such as multiple sclerosis or Parkinson’s disease or traumatically acquired damage to the central nervous system can then be identified as triggers.

Symptoms, complaints, and signs

Muscle hypotonia is initially manifested by balance disorders, muscle stiffness, and paralysis. In the long term, there are developmental delays in the musculoskeletal system, which can result in deformities and muscle pain. Muscle weakness also affects the respiratory system and lungs. Possible symptoms include speech and swallowing disorders and shortness of breath. In some patients, voice color changes or complete voice loss occurs. If muscle hypotonia progresses further, an exhaustion syndrome sets in. The child then complains of pain and fatigue after physical exertion, often accompanied by increasing listlessness. The decreased activity is usually associated with loss of appetite and emotional upset. If the cause of muscle hypotonia is not treated, the symptoms progress. This quickly leads to a decrease in quality of life and well-being. In addition, poor posture develops as a result of the weakness, which is associated with further health risks. Possible consequences of persistent poor posture are joint wear, muscle pain and tension. Muscle weakness can also promote circulatory disorders and sensitivity problems. The vessels are also strained by the reduced muscle activity. If diagnosed early, the symptoms of hypotension resolve quickly. The majority of patients are symptom-free no later than one to two months after treatment of the cause.

Diagnosis and course

Suspicion of muscle dysfunction in young children is usually raised by the parents. Muscle hypotonia is noticeable by very little movement compared with the age group, great effort, for example, during breastfeeding, and decreased ability to lift the head. A visit to a pediatrician is strongly recommended in this case. The pediatrician will take a detailed history of the symptoms observed by the parents and possible risk factors before performing a thorough physical examination of the child. The diagnosis varies according to age; the patient’s posture when standing and walking, lying and sitting, his or her movement abilities and motor endurance are relevant.Ultimately, it must also be diagnosed which muscle groups are most severely affected. The prognosis of muscle hypotonia depends on the underlying disease present; no general statement can be made.

Complications

In general, muscle hypotonia itself is already a complication. For this reason, the underlying disease that leads to muscle hypotonia is treated first and foremost. The complaint itself can significantly limit the daily life of the affected person and lead to discomfort during movement and various activities. Likewise, the development of the child is significantly limited by the disease. Patients suffer from severe muscle weakness and thus also from a significantly reduced ability to cope with stress. The patient’s posture is also not straight and can thus have a negative effect on adulthood and possibly lead to irreversible consequential damage. The muscles appear very weak, so that even the practice of various sports is usually no longer possible for the affected person. The treatment itself takes the form of treatment of the underlying disease. It is usually not possible to universally predict whether complications will arise in the process. With the help of various therapies, most of the symptoms can be alleviated and limited so that no consequential damage occurs in adulthood. The patient’s life expectancy is usually not limited by muscle hypotonia.

When should you see a doctor?

Muscle hypotonia disorders are considered unusual. If they persist or if the symptoms increase in intensity, a doctor is needed. If general physical performance decreases, medical advice should be sought. If there is pain in the muscles, paralysis, or limitations in the natural range of motion, a physician should be consulted. If there is a developmental delay in children, disturbances in the swallowing act or problems with phonation, a doctor should be consulted. Apathy, apathy or reduced well-being are signs of an existing irregularity. Clarification by a physician is necessary as soon as the complaints persist over several weeks or show an increasing tendency. If the affected person no longer takes part in usual social activities, or if mood swings or other behavioral abnormalities occur, a visit to the doctor should be made. If there is a loss of appetite, an unwanted decrease in body weight or an increased need for sleep, the organism is impaired. If there are sleep disturbances, abnormalities in the voice or changes in the skeletal system, a doctor is needed. In case of a permanent bad posture or a crooked body posture during locomotion, a timely correction must be made to avoid lifelong disorders. If the affected person can no longer participate in usual sports activities due to the impairments, a doctor should be consulted.

Treatment and therapy

Treatment of muscle hypotonia is twofold: on the one hand, the underlying disease must be treated as well as possible; on the other hand, physiotherapeutic measures are used to try to expand mobility. The underlying diseases can be treated differently depending on the severity and the exact syndrome: While there is no effective therapy for either Edwards syndrome or Pätau syndrome, and children with these trisomies have a fundamentally low life expectancy, the chances are better for those affected by Down syndrome. Affected children have prospects of almost normal movement behavior if they receive good early support with remedial education, occupational therapy, physiotherapy and psychomotor procedures. Muscle hypotonia caused by alcohol embryopathy can also be treated so well that affected children can achieve almost normal movement behavior. Physiotherapeutic measures aim at improved postural control, conscious fine motor movements and a dosed application of force. The exercises to be learned and the duration of treatment depend individually on the muscle groups affected and the severity of the symptoms. The exercises can be done on equipment, for example in a roller barrel or on the so-called horse, and without aids and must be performed daily.

Outlook and prognosis

Patients have a good chance of living with near-normal movement behavior if early intervention and occupational therapy as well as physiotherapy therapies are provided in a timely manner. In this context, the therapy measures are aimed at improved postural control, as well as more conscious fine motor movements with dosed application of force. The learning of the exercises as well as the duration of the therapy depend individually on the affected muscle parts and the occurring symptoms. These exercises can be performed on special equipment and also without any aids. Patients should perform the exercises daily. The disease can considerably restrict the patient’s everyday life. Muscle hypotonia leads to discomfort when moving and performing various activities. The development of affected children is also very significantly restricted by muscle hypotonia. The affected persons suffer from a very strong muscle weakness and thus also from a strongly reduced load capacity. The posture of those affected is also not straight and thus has a negative effect on later development. The incorrect posture can even lead to incurable consequential damage. In general, the muscles are very weak, so that the practice of various sports is usually no longer possible for those affected. With the help of various treatment methods, however, most of the symptoms can be alleviated so that later consequential damage does not occur. As a rule, life expectancy is not limited.

Prevention

Since the causes of muscle hypotonia are diverse and not all underlying diseases can be influenced, there are no prevention options. It is recommended to pay attention to a healthy diet during pregnancy that is not harmful to the child.

Follow-up care

There are usually very few and often limited measures of direct aftercare available to the affected person with muscle hypotonia. For this reason, the affected person should contact a physician as early as possible to avoid other complaints or complications. The earlier a doctor is consulted, the better the further course of this disease usually is. An early diagnosis usually has a positive effect on the further course of muscle hypotonia. The affected persons themselves are usually dependent on the measures of physiotherapy and physiotherapy. Many of the exercises can also be performed in the patient’s own home in order to accelerate the healing process. Likewise, parents should pay attention to proper posture in their children to alleviate the discomfort. Often, sufferers of muscle hypotonia also depend on their own family for help and support in their daily lives. This can also prevent depression and other psychological upsets. Contact with other patients of the disease can be very useful, as it is not uncommon to exchange information. The disease usually does not reduce the life expectancy of the affected person.

This is what you can do yourself

Muscle hypotonia requires extensive medical treatment and monitoring. The most important self-help measure is to regularly adjust drug and physiotherapy therapy to the patient’s current state of health. In this way, the progress of treatment can be optimized and, in the long term, the quality of life and well-being of the person affected can also be improved. Assuming good early support with physiotherapy and psychomotor procedures as well as occupational therapy measures, there is the prospect of a normalization of movement behavior. However, this requires the patient to perform daily exercises to strengthen the muscles. Accompanying this, a change or adjustment of lifestyle habits is indicated. Exercise and a healthy and balanced diet are important cornerstones of the treatment of muscular hypotonia. In addition, the physician will recommend therapeutic counseling to the patient. During a consultation with a specialist, the many problems associated with muscle hypotonia can be discussed. If desired, the therapist can also establish contact with other sufferers or refer the patient to a self-help group. Taking the prescribed medication regularly is equally important. Optimally adjusted medication reduces the typical pain and thus also prevents any secondary diseases such as premature joint wear or incorrect posture.