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Neurology (Expert Forum)
Post-stroke clonus? Myoclonus?
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Post-stroke clonus? Myoclonus?
by veedeo, Jul 09, 2005 12:00AM
My husband had a severe stroke at age 19 (clot); his family has a history of early stroke. He has recovered approximately 85-90% of the use of his left side, and there is no speech impairment.
When he is asleep, even during naps, his left leg vibrates. It has gradually been getting worse; last night it was at a level that can only be described as violent. It now wakes him up, which never happened before.
He has been on Zoloft for clinical depression (family history for that as well) for the last 10 months, and over that time the vibrating has gotten markedly worse. My questions are:
1. Does this sound like clonus or myoclonus?
2. If not, what other things could it be?
3. Is it something to be concerned about?
4. Would the Zoloft have any effect on it?
5. Is there anything that can be done to alleviate it?
Thanks.
When he is asleep, even during naps, his left leg vibrates. It has gradually been getting worse; last night it was at a level that can only be described as violent. It now wakes him up, which never happened before.
He has been on Zoloft for clinical depression (family history for that as well) for the last 10 months, and over that time the vibrating has gotten markedly worse. My questions are:
1. Does this sound like clonus or myoclonus?
2. If not, what other things could it be?
3. Is it something to be concerned about?
4. Would the Zoloft have any effect on it?
5. Is there anything that can be done to alleviate it?
Thanks.
Doctor's Answer
by CCF-Neuro-M.D.-PW, Jul 12, 2005 12:00AM
1) yes it could indeed by clonus, an expression of spasticity in that limb, which can get worse over time (hence it is getting worse as you describe it).
2) Less likely if focal seizures arising from the area of the stroke - this can be evaluated for by an EEG - a neurologist could tell by looking at it whether it is a seizure or clonus also.
3) Seizure of course should be treated with medication but clonus treatment depends on the degree of pain or disability associated with it. treaments include muscle relaxants (perhaps just at bedtime) such as baclofen, xanaflex etc or botox injections.
4) probably not
5) see 3. In very severe cases, a pump can be placed to deliver an antispastic medications directly into the spinal cord, although this can also limit the ability to walk by the legs being too floppy.
2) Less likely if focal seizures arising from the area of the stroke - this can be evaluated for by an EEG - a neurologist could tell by looking at it whether it is a seizure or clonus also.
3) Seizure of course should be treated with medication but clonus treatment depends on the degree of pain or disability associated with it. treaments include muscle relaxants (perhaps just at bedtime) such as baclofen, xanaflex etc or botox injections.
4) probably not
5) see 3. In very severe cases, a pump can be placed to deliver an antispastic medications directly into the spinal cord, although this can also limit the ability to walk by the legs being too floppy.
Best of luck -- and i'd look up a neurologist in your area that has dealt with myoclonus before. Also, I'm way off any SSRI and am now on Lamictal (lamotrigine) for depression. It is cleared by the FDA for seizures and for depression (in a bi-polar patient) and has worked very well with me for depression -- it doesn't take away the tics, but it makes me a lot happier than I've been in years -- since the zoloft issue.
M.