ankle clonus in preemie

I need the advice of a speacialist to help me out.
My son daniel was born at 30 week gestation and is now 4 months  (2 months adjusted). He had no major complications in the NICU while he remained there for 2 months. Since he's been home I can't help but notice that he has ankle clonus. He has no muscle rigidity or floppiness. His neonatologist said he looked good upon examination. I am very concerned about the way his ankel twitches when it's flexed backward. Somtimes it can twitch for up to 15 seconds and sometimes it dosen't twitch at all. This is something that has slowly been improving, however I'm still afraid of a cerebral paly diagnosis. Can anyone please tell me what this can mean and what other things I should be aware of in this case?

[Dr_Smita_S]

Hi. Thanks for writing in.

Although the early signs of cerebral palsy are usually not noticeable at birth, there may be a few warning signs present. The commoner ones are lack of muscle coordination, stiffness of muscles, exaggerated reflexes, excessive drooling and difficulties swallowing or sucking.

Presence of ankle clonus also indicates some kind of neurological deficit in an infant. An involuntary shaking or jerking of the leg and calf muscles is seen, when the toe is placed on the floor with the knee slightly bent. This is due to reflex spasms in the calf muscles.

Ankle clonus can be measured by the duration for which it occurs and can be classified as none, mild (less than 3 seconds), moderate (between 3 and 10 seconds), or severe (more than 10 seconds).

A type of cerebral palsy is known as Ankle Clonus Cerebral Palsy and is seen in some infants who exhibit ankle clonus during the first year of their life.

Whenever any degree of ankle clonus is suspected in an infant, a neurologist and pediatrician opinion should be sought at the earliest through complete clinical evaluation. The other important factors in establishing a diagnosis are the age of the infant, the degree of positive response and any other coexisting neurologic signs.

Regards

[Akbari]

hi mommy, I have seen so many cases whch were not full term like your baby and have shown the signs of hypertonocity and/or exagerated reflexes at the first mounths. most of these cases show symptoms like diplegic CP. but I should say that it has grade by itself. for exammple I have had cases which their signs has started from rigidity of limbs but no problem in neck, the other case showed signs of spasticity in low limbs and hypersensitivity, and some others may start from delay in developmental milstons such as neck righting, sitting and etc.
your baby in my mind is showing a very mild symptoms of CP by starting from clonus,  at first you should do something:
check your baby that if he have good head control. does he keeps her neck and head when you try to help him to sit from supine position (liying on his back)?
does he have any desire to hold object or reaching them?
is he hypo or hyper sensitive to tactile stimulation? does he tolerate his clothes cries alot and etc.
each of these signs are important and you should start theraputic interventions for them.
another point that I should remind is that according to your report it seems that signs are very mild and can be controlled if you start soon!

good luck!
  

[mommyof30weeker]

I took my son to his pediatrician and I was adviced that if something were wrong there would be more then just the clonus. My son's ankle did not show signs of clonus upon examination. He still does have signs of clonus at home but they are becoming less frequent as he is growing. my son is almost three months corrected. He for the most part has good head control with mild head lag (his head is huge). he does reach for and grab things, he laughs and is beginning to follow things instead of just focusing on them. I'm not sure what tactile stimulation is. I know that his nervous system is still immature. I'm hoping that the clonus will resolve in time and that it is due to a premature nervous system instead of cerebral palsy.

[Akbari]

OK. I told you that it doesn't seem to be a serious matter. there are 2 points in your report: is the head bigger than normal? it is just a question. if yes, it can influence the head control of course and you have searched its reason for sure. and the other point is following the objects. does he do it by his eyes or just by his head. if he doesn't separate eye and head movement it is better to start some exercises to separate these two.

[mommyof30weeker]

thank you for your reply. My son's head is bigger than normal. he still moves his head when following things with his eyes. how do I work on seperating the two? just wondering, how do pediatricians diagnose cerebral palsy in babies? and of the babies who do show mild signs of cerebral palsy, how do you predict the extent of the disability?

[Akbari]

at first I should remind you that the diagnosis of cerebral palsy specially in very mild cases is the task that should be done by a pediatric neurologist. of course I'm not sure that your baby is in the category of cp. about separating eye and head movement, because your baby is so young you should do it in a play manner. in lying position keep his head in your hand gently and try to fix it face to face (don't pressure it should be like directing it) then try to guide his attention to a toy that he likes. keep the toy in front of his eyes (with 20-30 cm distance from face) then go slightly to horizontal direction. continue the range to that extend which he follows. at first just work on horizontal direction then try vertical and after that diagonal.
I hope the explanation can help you....

let me know the result
thank you

[JSM333]

Our son was born premature at 33 wks, and he did show signs of ankle clonus for quite some time (~4-5 months) and there were times when it was sustained indefinately (>20 beats) especially when he was asleep or very relaxed.  

While most doctors seemed dismissive of this, they could not provide me a lot of additional information to why.  As such I became pretty stressed out and turned to a lot of these message boards and poured over different cryptic medical studies such as www.ncbi.nlm.nih.gov/pubmed/9071490 that did NOT make me feel any better.

In any case, I want to post on these to let everyone know that my son is 100% fine now @ 7 months (it was NS immaturity) and it's ME who is still recovering from the anxiety of this experience.

Through all of this, I've learned that in the case of ankle clonus- the overall health of your child plays a big part of whether this is an issue or not and chances are if *it* is of concern, you probably are already working with your doctors to around more significant hurdles such as muscle tone abnormalites and motor development.

Above all, a nurse once told me at the height of my anxiety that children are amazing in their ability to heal and overcome any obstacle- so no matter the case I truly believe think will be much better than your fears will lead you to believe.

Please take care of yourself and best wishes! :0)

[SDD629]

Thank you so much for your post.  I have a son who was born at 34 weeks and has severe ankle clonus.  Everything else have been fine, he eats well and smiles but I have been terrified that he will have CP.  The Dr says just was and see but that is easier said than done.  Your post has given me hope! I too read that study and it made me cry!  Thanks so much for sharing!