Myoclonia is the term used to describe involuntary muscle twitching. Only after a certain degree of severity and in symptomatic association with neurological diseases do myoclonia have clinical disease value. Treatment of patients is based on the causative disease.
What is myoclonia?
Myoclonias are not actually a disease themselves, but are classified as accompanying symptoms of various neurologic diseases. Because they can be symptomatic of numerous diseases, they are relatively nonspecific accompanying symptoms. Patients with myoclonia 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 classified as 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 myoclonias are pathological. For example, myoclonias occur physiologically in the form of twitching to sleep as the muscles relax. Myoclonias following muscle overload are also not pathological. The twitches may be rhythmic or arhythmic and may have different intensities of movement. The muscles of the extremities close to the trunk are most frequently affected. If voluntary movements occur simultaneously with the myoclonias, there is talk of action myoclonus. If the twitching is traceable to external stimuli such as light stimuli, medicine refers to it as reflex myoclonus.
Causes
Natural myoclonia without pathologic value can occur both during the phase of falling asleep and after more intense muscular exertion, signaling the relaxation phase of the musculature. Myoclonia with pathological value may have their cause in various neurological diseases. Most commonly, they sometimes occur in the setting of epilepsy, such as juvenile myoclonic epilepsy or progressive myoclonus epilepsy. However, non-epileptic disorders may also be accompanied by myoclonia. Unlike the epileptic variety, the myoclonias of other disorders are amenable to stimulation. Syncope shows myoclonias as a symptom. Simple tics, neurodegenerative diseases, and shuddering attacks may also be accompanied by myoclonias. Some myoclonias result from cortical damage, as may be present in Creutzfeldt-Jakob disease; metabolic, viral, and toxic encephalopathies; acute posthypoxic or chronic posthypoxic myoclonus syndrome; and anticholinergic syndrome, Schwartz-Bartter syndrome, or acute intermittent porphyria. Many other diseases and traumas can cause spinal damage that may also result in myoclonias. 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
- Schwartz-Bartter syndrome
- Trauma
- Epilepsy
- Porphyria
Diagnosis and course
Myoclonia manifests as jerky rhythmic or arrhythmic twitching of the muscles and may be focal, multifocal, or generalized. Contraction and subsequent relaxation of the affected muscles follow each other rapidly. The intensity of movement varies between weak and strong degrees. The muscles of the extremities close to the trunk are most commonly affected by the twitching. Apart from this, patients may also complain of myoclonias of the facial or trunk muscles. The twitches do not necessarily have to be associated with impairment in daily 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 accompanying symptoms may occur. In acute cases, these range from severe headaches to impaired movement and organic impairment with a highly variable range of symptoms.In the case of metabolic damage to the brain or spinal cord, specific symptoms may also occur for the organ insufficiency present in each case, for example, proteinuria in the case of causative kidney damage. The physician recognizes by visual diagnosis whether a patient is affected by myoclonia. As a rule, only myoclonia above a certain degree of severity give him cause for further examination and clarification of the primary cause. In most cases, the primary cause has already been diagnosed before the onset of severe myoclonia, such as renal insufficiency causing encephalopathy. In some circumstances, the physician uses imaging techniques such as MRI to image the spine and brain to further investigate the cause and determine the condition. The patient’s prognosis depends on the primary disease causing each condition.
Complications
Myoclonia, or muscle twitching, occurs primarily in the setting of an epileptic seizure. This can last for a few minutes, but in the worst cases it can also lead to status epilepticus, which lasts for more than 20 min and is usually accompanied by unconsciousness of the affected person. This is a medical emergency and should be treated immediately. The lethality of status epilepticus is about ten percent. Typical myoclonias can also occur in Creutzfeldt Jakob disease. In this disease, the brain is affected by prions, which cause degenerative changes. In addition, patients are more susceptible to urinary or respiratory infections. After a period of time, the brain is no longer able to control vital functions and the affected person dies. Furthermore, Schwartz-Bartter syndrome, an increased release of ADH, also causes muscle twitching. As a result of the ADH, there is a lower concentration of sodium in the blood, which can lead to fatigue, confusion and even coma. Acute intermittent porphyria usually takes a good course, but it can also end in serious complications. On the one hand, it can damage the kidneys or the liver, and it also leads to high blood pressure. Respiratory distress, muscle weakness or changes in the skin can also be complications of porphyria.
When should you see a doctor?
Myoclonia manifests as involuntary and uncontrollable twitching of the muscles. The condition is basically not a disease in its own right, but a symptom of other conditions. These are neurological in nature and can also lead to epilepsy. Whether it is necessary to go to the doctor or even to a specialist depends on the severity of the disease. A simple muscle twitch does not require an urgent visit to a physician. In this case, it is sufficient to tell the family doctor about the occurrence of myoclonia in the course of the annual routine examination. An experienced family doctor can determine by a visual diagnosis whether the condition behind the myoclonia requires treatment or not. At a certain level of severity, where the patient is seriously suffering from the muscle spasms, a visit to a neurologist is mandatory. The disease can affect the face and cause twitching, which, of course, leads to inability to work. Even people in dangerous professions cannot work if uncontrollable twitching of the overall musculature occurs. Myclonia is basically not life-threatening to the patient. However, the symptom may provide clues to a deeper disease that may well be dangerous. If you feel that you cannot control yourself at times, you should consult your family doctor.
Treatment and therapy
Myoclonia is merely a symptom of a larger condition. Ultimately, without knowing the cause of myoclonia, little can be said about the indicated therapeutic steps. Treatment usually focuses predominantly on therapy for the causative disease. Myoclonia following spinal, cortical, or other damage to the central nervous system usually cannot be treated causally. Once the damage has occurred, it usually cannot be completely reversed. The symptom of myoclonia is therefore mainly addressed with supportive therapy steps. These supportive steps primarily include physical therapy and occupational therapy. Physiotherapeutically, stroke patients have already succeeded, for example, in transferring the functions of a damaged brain area to an intact area.Such a transfer is also conceivable, if necessary, to alleviate or even eliminate myoclonia. In myoclonias with causative peripheral nerve damage, there is sometimes the possibility of complete regeneration of the affected nerve tissue.
Outlook and prognosis
In myoclonia, in addition to the twitching of the muscles, there is a very severe headache. These can also cause dizziness and nausea, severely affecting the patient’s life. The twitching in myoclonia itself does not necessarily lead to an impairment of life. In most cases, the disease also causes damage to the organs and spinal cord. In this case, the kidneys are particularly affected. If myoclonia occurs after an epileptic seizure, it must be treated immediately. Myoclonia often causes restriction and inflammation of the respiratory tract. As a result, shortness of breath and weakened muscles occur. Treatment of myoclonia depends primarily on the primary cause of the disease. Often, the disease cannot be treated specifically. However, its symptoms can be limited so that the patient can lead an ordinary life. If no organs are damaged in the course of myoclonia, there is no decreased life expectancy.
Prevention
Mild myoclonia without disease value affects approximately all people. However, those who do not overload their muscles and also practice relaxation techniques before bedtime will hardly notice the twitching. Strong and pathologically relevant myoclonias can be prevented only to the extent that the causative diseases can be prevented.
What you can do yourself
Severe myoclonia should always be treated by a specialist. Accompanying this, patients can increase their chances of recovery with physiotherapy and occupational therapy. For stroke patients in particular, a comprehensive physiotherapy program is recommended, based on the patient’s degree of disability and circumstances. Mild muscle twitching can be reduced by relaxation, walking and exercise, among other things. If they occur frequently, various relaxation methods such as yoga or autogenic training can help reduce myoclonias. In addition, triggering stress factors should be minimized. Myoclonia may also be caused by a simple magnesium deficiency, which can be countered with a magnesium-rich diet. The mineral is particularly abundant in bananas, beans, broccoli and oatmeal. To prevent future spasms, it is important to drink enough and to take small breaks every now and then. Furthermore, stretching exercises, a relaxing full bath and abstaining from alcohol and caffeine help. The occurrence and intensity of the muscle twitches should be recorded in a diary. Those affected by moderate or severe myoclonias should work out an adequate therapy together with their family doctor or chiropractor.