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Neurology (Expert Forum)
CLONUS
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CLONUS
by PattyCee, Sep 06, 2006 12:00AM
Often upon awakening when I try to get up my legs shake really bad and I have to push them down to get up. In the past I have been told I have clonus of varying degrees. Is that related to clonus? Also please clarify what clonus is and it’s possible significance in either back problems and/or neurological. MRI’s, EMG’s are fine. Spinal Tap had one band that went away upon second tap. Evoked response posterior tibial marginal. I do also have back problems (soft tissue) that don’t show on x-rays or MRI’s. Thanks
Doctor's Answer
by CCF-Neuro-M.D.-SH, Sep 09, 2006 12:00AM
First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
The symptoms you describe can be related to clonus, and should be verified by a neurologist on examination. Clonus is an extreme form of hyper-reflexia that indicates spaciticity, and causes repeated reflex muscle jerks upon stretching of the muscle involved. For example when you place your toe on the floor this streches the achilles tendon/gastrocnemius muscle. If this there is some kind of damage to the spinal cord/central nervous system that leads to spasticity this can result in repeated reflex contraction of the gastrocnemius muscle leading to a "foot jumping" experience. There are a wide variety of problems that can lead to clonus, such as long standing disuse of your legs, metabolic derangement, spinal cord pathology (MS, tumor, tethered cord, etc.) and/or brain disorders such as MS, stroke, tumor, cerebral palsy, etc. I would make sure that you have had an MRI of you entire spine/brain with contrast. If negative, then maybe a CT myelogram (dye study) would be helpful (to rule out tethered cord, etc.) A tethered cord is when your spinal cord becomes attached to the adjacent structures and is being pulled on over time (examples include tethering due to scar tissue, lipoma, etc.)
I hope this has been helpful.
The symptoms you describe can be related to clonus, and should be verified by a neurologist on examination. Clonus is an extreme form of hyper-reflexia that indicates spaciticity, and causes repeated reflex muscle jerks upon stretching of the muscle involved. For example when you place your toe on the floor this streches the achilles tendon/gastrocnemius muscle. If this there is some kind of damage to the spinal cord/central nervous system that leads to spasticity this can result in repeated reflex contraction of the gastrocnemius muscle leading to a "foot jumping" experience. There are a wide variety of problems that can lead to clonus, such as long standing disuse of your legs, metabolic derangement, spinal cord pathology (MS, tumor, tethered cord, etc.) and/or brain disorders such as MS, stroke, tumor, cerebral palsy, etc. I would make sure that you have had an MRI of you entire spine/brain with contrast. If negative, then maybe a CT myelogram (dye study) would be helpful (to rule out tethered cord, etc.) A tethered cord is when your spinal cord becomes attached to the adjacent structures and is being pulled on over time (examples include tethering due to scar tissue, lipoma, etc.)
I hope this has been helpful.
Yes, that is the only time I get shaky legs like that. They often feel strange and tight, but as far as the actual shaky legs that I described, it's only upon awakening.
( I do get intense fatgiue in my legs after walking too much, which nowadays is only 1/4 mile. Everything began 15 years ago after I had an electrical zapping sensation in my foot near a foot neuroma & I have never been the same since. Shaky legs, and various "neurological" sensations began immediately after that "attack." )
Any info. about clonus with regards to "shaky legs" or such is appreciated. Thanks.
Is that the only time you see them, and they go away copletly by pushing down your feet? ever happend while standing?
Bob
From your description , it sounds like Orthostatic tremor . Hyperreflexia is not uncommon in young healthy people especially if no other signs to suggest a neurological disease.
1-Orthostatic tremor is a tremor of the legs only when standing 2-It is typically not present
a-when making voluntary movements of the legs
b-when lying down
c-nor is is present with walking
3-The site of the central generator is unknown ? be from the posterior fossa.
4-SPECT scanning for the dopamine transporter showed a symmetric deficit in certain area of the basal ganglia (both putamen and caudate).
5-BUT,Orthostatic tremor might be an abnormality of the normal response to instability (if placed in unstable situations) which doesnt look like your case.
6-The classic treatment is with clonazepam. Gabapentin may help.
7-Some recently published case reports, described unusual systemic causes:
a-Whipple disease
b- B12 deficiency
c- Celiac disease
d- Thyrotoxicosis
Worth ruling them out.
Bob
iam 50 years old 2003 i find out that only inthe afternoon where i was coachin soccer team ibegan to have stif right leg couldent run or kik the footbal imidiatly went to dr didnt know said maby perpheral criculatory prolblem with vitamin b12 deficiency so i took traetment nothing happend continue worsening went to orthopedic , cardialogist neumologist internal medicine, all negative full blod test negative of all thyroid normal went to neurosurgent , by then january 2004 it was heavy rain i tried to mop the floor i begin to fall i had clonus on my right leg my left index figer was not functioning corectly began to have vision problem needed glases nurosurgent find i have hyper reflxia in all my joint specialy right leg
mri brian wass unrmarkable , c3 toc7 showed borderline stenosis and ostifite in anterior of my vertebral body of c3 c4 c5 c6 c6 c7
cold wheather mad my spcticty so bad that i nedded walker to get around electromygraphic was some litle motor neuron problem not significant enough to sucpect any degenarative disease like als ms or others neurosurgent said neck surgey only way to go but he wanted corpectomy with hipe bone fixation. which i refused.
got worsed and went to hospital er they didnt find anything neurologist at first was very much against the neck surgery but couldnt find any thing gave me stiroud therapy for a15 days inter vinesly my situation got so bad that he send me to another neurosurgent which in augost 18 2005 he perormd posretior lminoplasty and released from hospital with alot of pain and spacticity imy right and left leg oct 2005 post op mri with contrast showed no stenosis improvment he was mad with radialogist that he see improvement but he said he dosent know what is wron probebly extrapyramidal problem send me to neurology went there by dicember i was given evry posible test genetic viral very long chanie of aminoacide and lubar pucher no result was given by february send me to physicalmedicine which gave lyrica gabapentinaa baclofen and many more march 2006 my condition is so bad that i have pain 24- 7 cervical through L5 so bad that i can even take ashower bu physical medicine wants baclofen pump installed i refused because no diagnosis has been made yet . i am so bad but ihave phylosophy that my two boys need me to be though so i keep it to myselfe do .
thank you for this and hope you know somebody to tellme where to go or anything thanky again hope you all have healthy life