Myoclonus

Hello Dr., I am a proud dad of an amazing 7 month old who last Monday started some strange behavior.  It started when his mom put him in a bath at 10 am after a long day of short, inconsistant naps to try and make him more tired.  She said that towards the end of the bath his head kept bobbing down, his arms would close in, and his body would tense up.  He would also make a tense face.  She thought he was just getting cold but she did say that it was very uncaracteristic of him to do this.  He didn't cry, it would be brief bouts of his head flung down and then back up again.  It happened again 2 days later.  My son, wife, and I were on the floor playing and he started in again.  His head looked to be thrown down to his chest, his arms would tuck in, and he would show his gums.  It did not look intentional so I grabbed my iphone and filmed the attack.  It lasted about 4 minutes.  We made an emergancy apt for our pediatrician and showed him the video.  Our son actually bowed his head a couple of times for the docter but nothing like the night before.  The pediatrician said based on everything that I have seen and the times that these occurred, he diagnosed my little one with Myoclonus.  He said to monitor it very closely and if it starts to happen more frequently then we need to go see a Neuro Pedi.  I asked him if this was common and he said no and this could take one of two courses.  One being something to not worry too much about and the other may be related to epilepsy.  Now, his mother and I are a mess after googling Myoclonus and seeing similar videos of other babies with this condition.  He has not had an episode like he did those two times but does nod his head every once in a while.  I'm not sure what arm movements are normal or not and I am driving myself crazy just watching him.  How often are these things benign?  Do you suggest we just call our Pedi and ask to see the Neurologist right away?

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

Myoclonus are brief shocklike episodes of muscle contraction. They can, as you mention,have a benign or a malignant course. The most common causes are benign (e.g., many people experience this as they are falling asleep and awaken with a brief jerk; other causes could be anxiety, exercise, hiccup, eating, etc). However, some are malignant, such as the epilepsies. Some are hereditary and can be benign.

It is good that your son has not experienced any additional episodes. Has he been treated with a medication for them or was it a one time event? I do agree that seeing a pediatric neurologist is a good idea. It does not sound like there is urgency at this moment. He/she may or may not want additional testing (depending on what other information is provided in the history and examination). Many times, an EEG to look at the electrical nature of the brain is performed.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[Diggitty]

Thank you so much for the reply.  He is not on any medication for them as of now.  Here is our update and I would love to hear what your opinion would be.  Last Friday, we were scheduled for an EEG at 9:45 am.  They said to bring him in very tired.  So we made him miss two normal naps and he was very fatigued we did the EEG.  About half way through he fell asleep.  We went to the neurologist yesterday and he said the EEG was completely normal. He checked out our son and watched the 5 videos of his "episodes."  He carefully watched every one and dismissed 4 of them as babisms, or nothing to worry about.  The one video that he did notice he watched over and over.  He said it seemed like our son was sort of out of it when these jack knife like episodes were happening.  He said it was hard to tell though.  He asked if we brought him in to his office for an 8 hour EEG did we think we could catch any more of the episodes that he said looked suspicious.  We said no because it always happens from about 7pm on.  The docter said epilepsy should be spontaneous and throughout the day so it only happening at night kind of contradicts it being epileptic.  He said to watch for the episodes throughout the day for 2 weeks and catch it on camera again if we can.  So, I guess my question is, was it good news that he had a normal EEG even though it was early in the morning?  Also, could it be excessive excercise towards the end of the day that trigger arm and trunk spasms?  Thank you so much for your input.