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Involuntary muscle movements, also known as myoclonus, are any motions made by the body that are outside of one's control. They can range from small movements, such as eye twitching, to larger movements affecting the body. Myoclonus is a brief, sudden muscle movement that can be caused by a variety of factors, including chronic diseases, medication side effects, brain injuries, strokes, trauma, or a lack of oxygen in the brain. In some cases, infections can also lead to involuntary muscle movements. Opsoclonus myoclonus syndrome (OMS), for instance, is a rare condition that can be triggered by bacterial or viral infections, causing irregular eye and muscle movements. Chorea is another example of an infection that can cause involuntary muscle movements, affecting the arms, legs, and facial muscles.
| Characteristics | Values |
|---|---|
| Involuntary muscle movements | Myoclonus, twitching, tremors, seizures, athetosis, chorea |
| Causes | Chronic diseases, medication side effects, brain injury, stroke, trauma, lack of oxygen in the brain, infection, epilepsy, metabolic disorders, kidney or liver failure, chemical or drug intoxication, lipid storage diseases, autoimmune inflammatory conditions, head trauma, spinal cord injury, cancer |
| Treatment | Medication, surgery, deep brain stimulation, behavioural therapy, physical therapy, swimming, walking, stretching, balance exercises |
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What You'll Learn
Opsoclonus-myoclonus syndrome (OMS)
In young children, OMS is most often caused by a tumour called neuroblastoma, which triggers the immune system to attack the nervous system. Neuroblastoma tumours are usually very small and are best removed using surgery. Chemotherapy or radiotherapy may also be required. The condition may also follow an infectious illness, especially in older children and teens. In adults, OMS is most often related to lung or breast cancers, but it can also happen on its own or after a bacterial or viral infection.
The cerebellum, an area of the brain responsible for coordinating eye movements, muscle coordination, and speech, is attacked in OMS. Around half of children diagnosed with OMS are found to have a neuroblastoma tumour, which is usually benign. OMS can be difficult to diagnose, and a specialist centre is advised. Diagnosis involves extensive investigations, including an MRI brain scan and infection screening (blood tests and a lumbar puncture).
There is currently no cure for OMS, but treatment aims to address the underlying neuroblastoma tumour, if present, and prevent any lasting damage to the cerebellum. Treatment for OMS includes immunotherapy, which helps prevent the body's immune system from attacking the brain, and medications such as corticosteroids, intravenous immunoglobulin (IVIg), and rituximab.
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Chorea
The causes of chorea are extensive and include hereditary and acquired etiologies. A careful history, detailed examination, and laboratory tests may help narrow down the list of differential diagnoses. Management of the disorder focuses on treating the underlying cause, using medications like dopamine-depleting agents or antipsychotics to reduce involuntary movements. Treatment options may also include surgery, deep brain stimulation, or behavioural therapy.
The Committee on Classification of the World Federation of Neurology describes chorea as a state of excessive, spontaneous movements that are irregularly timed, non-repetitive, randomly distributed, and abrupt in character. These movements may vary in severity, ranging from mild, intermittent exaggeration of gesture and expression to continuous, disabling, violent movements.
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Myoclonus and seizures
Myoclonus refers to sudden, brief involuntary twitching or jerking of a muscle or group of muscles. The twitching cannot be stopped or controlled by the person experiencing it. Myoclonus is not a disease but a clinical sign of another neurological condition. Myoclonus can be caused by infections, head or spinal cord injury, stroke, brain tumours, kidney or liver failure, metabolic disorders, and drug reactions.
Myoclonic seizures are brief, sudden jerking movements of muscles that can be easily mistaken for tics, tremors, or clumsiness. They are caused by abnormal electrical discharges in the brain and can be a symptom of epilepsy. Myoclonic seizures can occur as single events or in clusters. They can be treated with medication and do not cause any loss of awareness—the person is awake and conscious during the seizure.
Myoclonus and myoclonic seizures are distinct but related phenomena. Myoclonus is a type of involuntary muscle movement that can be caused by a variety of factors, including infections and other physiological conditions. Myoclonic seizures are a specific type of seizure characterised by brief, sudden jerking movements of muscles, often occurring in clusters. While myoclonus can be a symptom of neurological conditions, myoclonic seizures are specifically associated with epilepsy and abnormal brain signals.
Myoclonus can be classified into different types, including focal myoclonus, multifocal myoclonus, and cortical myoclonus. Focal myoclonus affects a single muscle, while multifocal myoclonus involves multiple muscle groups. Cortical myoclonus is caused by irregularities in the sensorimotor cortex of the brain. Myoclonus can also be classified as positive or negative. Positive myoclonus involves muscles contracting suddenly, resembling muscle spasms. Negative myoclonus involves muscles suddenly losing tension, leading to a loss of grip or sudden movements.
Myoclonic seizures are often associated with specific syndromes, such as Lennox-Gastaut syndrome and progressive myoclonic epilepsy. Lennox-Gastaut syndrome typically includes other types of seizures and can begin in early childhood. Progressive myoclonic epilepsy is a severe type of epilepsy that worsens over time, leading to brain deterioration, memory loss, and muscle control issues. It is important to seek medical attention for accurate diagnosis and treatment options.
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Myoclonus and nervous system disorders
Myoclonus is a type of involuntary muscle movement that includes sudden, brief, irregular, and uncontrollable twitching, jerking, or spasms of a single muscle or a group of muscles. It is not a disease but a medical sign and can happen by itself or as a symptom of a wide variety of nervous system disorders. Myoclonus can be classified based on physiology, meaning the presumed source of its origin in the nervous system: cortical (brain), subcortical (between the brain and spinal cord), spinal, or peripheral (nerves outside of the central nervous system).
Most forms of myoclonus are caused by a disturbance of the central nervous system (the brain and spinal cord), although some cases are caused by an injury to the peripheral nerves. Myoclonus may also develop in response to an infection, head or spinal cord injury, stroke, brain tumours, kidney or liver failure, chemical or drug poisoning, metabolic disorders, or other disorders. In addition, certain medications, such as opioids, anticholinergics, psychiatric medications, antiepileptics, or cardiac medications, can cause myoclonus.
Myoclonus can also be classified by etiology, or the underlying cause. Some forms of myoclonus are idiopathic, meaning they occur in people with no family history and with no known cause. However, it is also possible for myoclonus to run in families, with essential myoclonus being associated with essential tremor or dystonia (myoclonus-dystonia). Researchers are working to better understand the underlying causes of myoclonus and develop new therapies for neurological disorders that can cause it.
Myoclonus is usually diagnosed by identifying what part of the nervous system is producing the myoclonus and establishing the cause. This may involve blood or urine tests to rule out other conditions, brain imaging, and genetic testing. While there are no medications designed specifically to treat myoclonus, medications that reduce an overactive nervous system are generally used to relieve symptoms. Other treatment options include surgery, deep brain stimulation, or behavioural therapy.
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Myoclonus and metabolic disorders
Myoclonus refers to fast, uncontrollable jerking movements that can be caused by dysfunction in the cerebral cortex part of the brain or the brainstem. It is a clinical sign and not a disease. Myoclonus can occur by itself or as a symptom of a nervous system disorder.
Myoclonus can be physiologic, which occurs in healthy people and rarely requires treatment, or pathologic, which results from various disorders and medications. Physiologic myoclonus may occur when a person is falling asleep and during early sleep phases (hypnic myoclonus) and can be focal, multifocal, segmental, or generalized. It can also be stimulus-sensitive, resembling a startle reaction. Examples include hiccups, sleep myoclonus, and benign tremors. Essential myoclonus occurs without an underlying medical condition and is sometimes an inherited disorder, but it can also arise in people with no family history of neurological disease. Hereditary essential myoclonus is synonymous with myoclonus-dystonia syndrome, which is due to mutations of the epsilon-sarcoglycan gene. Essential myoclonus is usually stable and doesn't get worse over time or progresses very slowly.
Pathologic myoclonus can result from various disorders, medications, or metabolic disturbances. Metabolic myoclonus may be multifocal, asymmetric, and stimulus-induced, involving facial or proximal limb muscles. If the metabolic disturbance persists, generalized myoclonic jerks and seizures may occur. Metabolic disturbances that can cause myoclonus include hepatic and renal failure, electrolyte disturbances (e.g. hyponatremia, hypoglycemia, nonketotic hyperglycemia), and inherited metabolic diseases. Myoclonus has also been associated with SARS-CoV-2 infection.
Treatment of myoclonus begins with correcting the underlying metabolic disturbance or other causes if possible. If a medication is the cause, it is stopped or the dose is reduced. Myoclonus due to toxic-metabolic causes may respond to medications such as clonazepam, valproate, levetiracetam, and piracetam, which are effective in cortical myoclonus but not in other types.
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Frequently asked questions
Myoclonus is a type of uncontrollable movement that includes sudden, brief involuntary twitching, jerking, or spasms of a single muscle or a group of muscles. It is not a disease but may be a sign of another neurological condition.
Yes, involuntary muscle movements could be caused by infections. Opsoclonus-myoclonus syndrome (OMS) is a rare condition that involves involuntary eye and muscle movements and can be caused by a bacterial or viral infection. Spinal myoclonus can be caused by multiple factors, including infection.
Involuntary muscle movements can be caused by several factors, including chronic diseases, medication side effects, brain injury, stroke, trauma, seizures, lack of oxygen in the brain, or movement disorders.
