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Neurology (Expert Forum)
Re: Myoclonus
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Re: Myoclonus
by CCF MD mdf, Jan 01, 1995 12:00AM
Posted By CCF MD mdf on August 19, 1998 at 10:03:13:
In Reply to: Myoclonus posted by G Lascola on August 19, 1998 at 00:16:30:
In the fall of '97 I moved away for graduate school for the first time. It was a time of great stress due to my course work, and I found myself studying all the time and thus very inactive. Well in November my neck started to twitch and now its my neck and right leg. It mostly happens during times of inactivity like sitting in front of the tv, computer, etc., and use to happen most right before I went to bed, although now, even though its still bad before bed, its frequency at the "relaxed" times are increasing and its also happening in the morning when I wake up. At night, I usually reach a point before falling asleep that it will stop and not occur until morning. I went to a board certified neurologist who put me through a lot of tests. I was given an EEG, an MRI, and some kind of shock test where he inserted this electic needle and gave me a shock that went through my body. He claimed that all the tests looked good at that he couldn't see anything wrong. He told me it was Myoclonus. He put me on
Depakote which made it worse and so I decided to discontinue its use and put up with the jerks which at the time (in December 97 was mainly locallized around my neck and was at the beginning stages of my right leg. Well within the past couple of weeks, I've returned back to school to this smog infested city, and it seems to be getting worse. Today was in fact the first day that I had a muscle jerk while I was active (walking on campus). I always do it now when inactive and I thought it may have happened in my left leg for the first time although I'm not certain. By the way, I can usually "make" one happen if I just think about it and its frequency seems to increase when I stress out about what's going on. I have no other symptoms except I sometimes get headaches, but that might be caused by my head jerking so rapidly which also brings up the question of whether neck jerking can have any side effects on my neck or brain. So if anyone can give me any insight as to what this might be or what's going on I
would appreciate it. Thanks for reading this novel.
=
Diagnosing jerky movements is a tricky thing, because our understanding of normal and abnormal motor physiology is murky.
The best way to get a diagnosis is to see someone who has seen the phenomenon before. Sometimes experienced general neurologists are able to tell the difference between normal and abnormal movements, and to distinguish types of abnormal movements based on phenomenology. But for the "hard" cases, you want a movement disorders specialist. Fancy tests are often not very helpful (though for myoclonus per se, we do use a very simple EMG study to demonstrate the duration of the burst, because voluntary vs involuntary burst durations are different, and we also sometimes use EEG to attempt to correlate muscle burst activity with cerebral cortical electrical activity).
So it's not clear to me that you have myoclonus, as opposed to tics or dystonia or something else. Can't even speculate without seeing you in person. Clearly, these symptoms are a problem, and I think it would be worth your while to pursue diagnosis until you have an answer.
Myoclonus per se can be difficult to treat. Certainly Depakote is one of the mainstays of treatment, but there are a few other medications as well. Part of the treatment decision comes from determining the source of the myoclonus: where in the nervous system is the abnormality?
You may benefit from seeking a second opinion with a movement disorders specialist. Contact your local academic medical center (usually associated with a medical school) or if you are close to Cleveland we have movement disorders specialists. If you wish to come here, call 800 223-2273 and ask for neurology appointments, ext 4-5559.
I hope this helps. CCF MD mdf.
In Reply to: Myoclonus posted by G Lascola on August 19, 1998 at 00:16:30:
In the fall of '97 I moved away for graduate school for the first time. It was a time of great stress due to my course work, and I found myself studying all the time and thus very inactive. Well in November my neck started to twitch and now its my neck and right leg. It mostly happens during times of inactivity like sitting in front of the tv, computer, etc., and use to happen most right before I went to bed, although now, even though its still bad before bed, its frequency at the "relaxed" times are increasing and its also happening in the morning when I wake up. At night, I usually reach a point before falling asleep that it will stop and not occur until morning. I went to a board certified neurologist who put me through a lot of tests. I was given an EEG, an MRI, and some kind of shock test where he inserted this electic needle and gave me a shock that went through my body. He claimed that all the tests looked good at that he couldn't see anything wrong. He told me it was Myoclonus. He put me on
Depakote which made it worse and so I decided to discontinue its use and put up with the jerks which at the time (in December 97 was mainly locallized around my neck and was at the beginning stages of my right leg. Well within the past couple of weeks, I've returned back to school to this smog infested city, and it seems to be getting worse. Today was in fact the first day that I had a muscle jerk while I was active (walking on campus). I always do it now when inactive and I thought it may have happened in my left leg for the first time although I'm not certain. By the way, I can usually "make" one happen if I just think about it and its frequency seems to increase when I stress out about what's going on. I have no other symptoms except I sometimes get headaches, but that might be caused by my head jerking so rapidly which also brings up the question of whether neck jerking can have any side effects on my neck or brain. So if anyone can give me any insight as to what this might be or what's going on I
would appreciate it. Thanks for reading this novel.
=
Diagnosing jerky movements is a tricky thing, because our understanding of normal and abnormal motor physiology is murky.
The best way to get a diagnosis is to see someone who has seen the phenomenon before. Sometimes experienced general neurologists are able to tell the difference between normal and abnormal movements, and to distinguish types of abnormal movements based on phenomenology. But for the "hard" cases, you want a movement disorders specialist. Fancy tests are often not very helpful (though for myoclonus per se, we do use a very simple EMG study to demonstrate the duration of the burst, because voluntary vs involuntary burst durations are different, and we also sometimes use EEG to attempt to correlate muscle burst activity with cerebral cortical electrical activity).
So it's not clear to me that you have myoclonus, as opposed to tics or dystonia or something else. Can't even speculate without seeing you in person. Clearly, these symptoms are a problem, and I think it would be worth your while to pursue diagnosis until you have an answer.
Myoclonus per se can be difficult to treat. Certainly Depakote is one of the mainstays of treatment, but there are a few other medications as well. Part of the treatment decision comes from determining the source of the myoclonus: where in the nervous system is the abnormality?
You may benefit from seeking a second opinion with a movement disorders specialist. Contact your local academic medical center (usually associated with a medical school) or if you are close to Cleveland we have movement disorders specialists. If you wish to come here, call 800 223-2273 and ask for neurology appointments, ext 4-5559.
I hope this helps. CCF MD mdf.
