Bilateral ankle clonus

[sheri123]

In November of this year I had a very thorough physical at Cooper Clinic. I am a 37-year-old female. Oddly enough bilateral ankle clonus (3+)  and overall whole body hyperflexia were discovered at the time of my physical. MDCT scan was performed along with CT of the head and neck, then subsequent MRI of the head and neck with and without contrast. Findings included a prominent disc bulge at C4-5 that indents the CSF space anterior to the cord but does not cause direct cord or root compression and no evidence of mass effect on the cord. Canal dimensions are normal. There is also a bulge at C5-6, at T2-3 and T3-4. These indent the CSF space anterior to the cord but are not producing appreciable edema or displacement of the cord proper.

The only other symptoms I have had that could even remotely be related to this is occasional mild body twitching that probably would go unnoticed by me if I were not becoming hypersensitive to anything that might indicate a problem and occasional tingling sensations along my neck and upper shoulders. I have normal gait and strength and negative Babinski.

Everything I read about clonus indicates a potential for MS or ALS. I have an aunt on my father's side with MS that has been fairly latent until recently..she was in her 30s at diagnosis but mainly without symptoms until now, in her early 60s. My MRI, however, did not show anything that would bear this out as a diagnosis for me. I am, obviously, terrified of anything that could indicate ALS but my understanding is that there is no definitive test for this disease.

I have chosen to this point not to pursue neurological consultation, as I am functioning pretty much normally and this has not affected any quality of life issues or restricted my activities. Occasionally the clonus makes itself felt when I am on an elliptical trainer or exercise bike but that is mild and minimal. If I have ALS, I figure it will manifest itself relatively soon and if I have MS, it too will eventually become obvious. I have no desire to go through rigorous testing that is mostly aimed at ruling out this that or the other rather than proving anything, particularly since I have no appreciable debility and even if something like ALS or MS were found, nothing would be done at this point to treat it or improve outcomes. However, I do wonder and worry. My primary care doctor seemed to feel the bulging discs were unlikely to be causing this. I have been on Wellbutrin XR for some time and we tried switching to generic to see if it would eliminate the clonus and then switched back to name brand when it did not. Getting off the Wellbutrin is not really an option at this time as I lost my 13 year old son just over a year ago and am still grieving.

My question is:

A.  Can a person have clonus and hyperreflexia on physical exam as a completely benign finding or is it always indicative of a problem?
B.  Could the bulging discs be a potential cause, and if so, should I be seeking treatment for them?
C.  Could this be caused by obesity and potentially cured with weight loss?
D. Is it possible to have a tumor or other spinal lesion and not have it show up on closed MRI with and without contrast?

Thank you in advance.

[Kristen2364]

Wow,  you sound a lot like myself except for the fact that I have a hard time walking.  The first onset of ankle clonus came on in my right ankle approx 20 years ago.  At that time, it came on suddenly and the onset actually started in my right knee while walking my dog.  My right knee appeared to buckle while walking as if a ligament was stretched.   I had every test known to man and they could not find a thing.  I also had mild bulging at L4-5 and neck problems.  However, all of my MRI's etc... came back within normal range.  Around 6 year ago, I noticed that the clonus appeared in my left ankle as well.   I also have severe writers cramp in my right hand/wrist.   Doctors diagnosed me with dystonia.  I have been to so many neurologists, movement disorder specialists, chiropractors, ortho's including a top neurologist at the Mayo Clinic.    All of my doctors honesty scratch their heads and have no idea what to say since they cannot find anything noticeable that links to an upper motor neuron problem.   The only thing that really ever made made sense was a doctor in Florida.  He said he felt as though these were  seizures of some sort and ordered a PET scan.  They did come back and said that I had a slight hypomotabolism in my left medial temporal lobe which could be causing a seizure disorder.   There are many types of seizures.   Severe anxiety runs in my family as I have found out over the years.  We get tense very easily.  I feel this is tied to the clonus. My ankle clonus has affected me physically as I cannot walk very well and can't keep up with my 2 daughters 7 & 10.  I have tried to rack my brain as to what has happended in the past that might have caused this and can come up with several things, but nothing concrete.    I have taken antidepressent medication since I was a young adult.   I have noticed that taking these medications have made my clonus worse.   I have done so much research on my own.  When you mentioned that you just started Wellbutrin it touched a nerve going back to the possiblity that I have a seizure disorder of some sort.  I recently decided that I wanted to taper off of Paxil and try Wellbutrin because a family member said it help her with her depression.   I have been completely on Wellbutrin (the generic brand) for a month now and feel as though I'm going to jump out of my skin.  I have noticed that the clonus definatley became worse while taking Wellbutrin.   I looked up Wellbutrin side affects today and everything said DO NOT TAKE IF YOU HAVE A SEIZURE DISORDER.

I decided today that the problem isn't depression, but anxiety for me that is causing the depression.   I am so sorry to hear about your Son, my hearto goes out to you.   But, with the clonus symptoms, I think that it can be exasperated by anxiety more than anything.  We need to learn to relax (as my first doctor ever told me when he couldn't find a cause)  of course I thought he was nuts.

For your situation with the depression, I would suggest an antidepressent that also has an anti-anxiety agent.  Talk with with doctor, but get off the Wellbutrin.  I started tapering off today.

I have done sooooo much research on clonus on my owne since the doctors can't figure out.  I would love to keep in touch with you if you would like and maybe we can share notes.  I am 43 years old and have not been able to come across anyone with a similar problem.   We will get thru this I have to believe.  Please e-mail me at ***@****

Kristen Brenan