Pedal clonus

  A recent neurologic exam uncovered bilateral clonus at the ankles (+2).
  The examination was related to a severe fall with trauma to Rt. hamstring
  group. No sensorimotor deficits noted on standard neurologic workup other
  than the above mentioned clonus.
  I am a 57 yr. old healthy white male, Ashkenazic jewish heritage. I take
  50 mg. Cozaar for mild hypertension probably secondary to 35 lbs. excess
  weight and smoking 1 pack of cigarettes/day. Active person, cycling 4x/wk.
  I also take 20 mg. Prozac/day for chronic depression. I have been on Prozac
  for only 1 month. I also take Xanax only when needed (0.5 mg) for paraspinal
  muscle spasms secondary to vertebral biomechanical instability as a result
  of an injury to the left Hallux 15  yrs. ago (average daily dose of Xanax
  is about 0.125 mg).
  QUESTION: Can my clonus be a result of mixing Cozaar, Prozac, Xanax and
            about 22 ozs. of standard beer/day (alcohol content = 3.4%) ??
            THANKS FOR YOUR HELP. !!!

[CCF Neuro MD MJD]

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Not sure exactly what your doctor's report says -  "2+" is actually a neurologist's description for a normal reflex.  Clonus is another thing and basically means that foot shakes rhythmically on reflex testing.  It is a nonspecific sign of hyperactive reflexes - some nonsustained jerks of clonus at the ankle is sometimes seen in normal people.  You can ask your doctor what he thinks the significance of it, but if isolated (i.e. no weakness, sensory complaints, urinary problems) it probably is not significant.  It's something that has to be evaluated in the setting of the entire neurologic exam.   Sometimes as we all age, we get a little neck arthritis which can cause active reflexes or mild clonus, but if no other problems or exam findings exist, no further workup is done.  As for your mixture of the above medications (especially Xanax and alcohol, you should alays be cautious, but it is probably unrelated to the reflex changes you note