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Involuntary muscle movements, also known as myoclonus, refer to sudden, brief, uncontrollable twitches or jerks of a muscle or group of muscles. They can be caused by a variety of factors, including chronic conditions, nerve damage, drug reactions, brain injuries, genetic disorders, metabolic disorders, infections, or spinal cord injuries. These involuntary movements can range from mild twitches to more severe tremors and seizures, and they can affect various parts of the body, including the arms, trunk, neck, and face. While some involuntary movements may be temporary, others can be chronic or permanent, and they can have a significant impact on an individual's socialization and acceptance by peers. Recognizing and diagnosing the underlying causes of involuntary movements are crucial steps in determining appropriate treatment plans.
| Characteristics | Values |
|---|---|
| Type | Tics, Tremors, Myoclonus, Athetosis, Dystonia, Hemiballismus, Chorea, Tardive dyskinesia (TD), Blepharospasm |
| Description | Quick, repetitive movements that can be motor or vocal-based |
| Severity | Involuntary movements can range from quick twitches to longer tremors and seizures |
| Causes | Chronic conditions, nerve damage, drug reactions, brain injury, spinal cord injury, multiple sclerosis, cerebral palsy, stroke, brain damage caused by a lack of oxygen, severe head injury, metabolic diseases, epilepsy, Parkinson's disease, infection, kidney or liver failure, chemical or drug intoxication, lipid storage diseases, autoimmune inflammatory conditions, COVID-19, Rett Syndrome, genetic disorders, low levels of oxygen in the brain (hypoxia) |
| Treatment | Anti-epileptic drugs like sodium valproate and carbamazepine, physical activity, surgery, Botox injections, medication (baclofen, diazepam, tizanidine, clonazepam, levodopa, amantadine, amitriptyline) |
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What You'll Learn
Myoclonus
There are several types of myoclonus, including spinal, peripheral, stimulus-sensitive, sleep, essential, action, and epileptic myoclonus. Spinal myoclonus begins in the spinal cord and can involve muscle groups controlled by connected parts of the spinal cord. Peripheral myoclonus refers to myoclonic jerks that originate from a peripheral nerve. Stimulus-sensitive myoclonus is triggered by external events such as noise, movement, light, or being surprised. Sleep myoclonus occurs during sleep and sleep transitions, often as a person is drifting off. Essential myoclonus occurs without any apparent abnormalities in the brain or nerves and is usually stable without increasing in severity over time. Action myoclonus is triggered by voluntary movement or the intention to move. Epileptic myoclonus occurs within an epilepsy syndrome, such as Juvenile myoclonic epilepsy (JME), which involves myoclonic seizures of the neck, shoulders, or upper arms.
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Tics
The exact cause of tics is not fully understood, but researchers believe they may be related to changes in the part of the brain that controls movement. Tics can also have a genetic component, as they can run in families. Additionally, tics may be influenced by emotional states, increasing as a result of stress, fatigue, boredom, or high-energy emotions, both positive and negative. Relaxing activities, such as watching television, may also increase tics, while concentration on absorbing activities can lead to a decrease.
While most tics are not dangerous or disruptive to a person's daily life and may not require treatment, severe tics that interfere with quality of life can be managed with medication or psychotherapy. A doctor can diagnose a tic disorder by taking a medical history and performing a physical examination, assessing the duration and frequency of the tic.
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Dystonia
The key symptom of dystonia is uncontrollable muscle movements, which can be uncomfortable or even painful, sometimes feeling like electric shocks. These movements are often repetitive, variable in duration, twisting or stretching in nature, and worsen when using the affected muscles. Dystonia can affect any part of the body, including the arms, legs, trunk, face, and vocal cords. The movements can cause a person to hold an unusual pose, and the effects of dystonia can worsen when feeling tired or stressed, or when consuming caffeine or alcohol.
There are five main types of dystonia: focal dystonia, segmental dystonia, multifocal dystonia, hemidystonia, and generalised dystonia. Focal dystonia is the most common type and is limited to one area of the body, such as the neck, eyes, jaw, vocal cords, or arms and legs. Segmental dystonia affects two or more adjacent parts of the body, such as the head and neck or arm and trunk. Multifocal dystonia affects two or more non-adjacent parts of the body. Hemidystonia affects one side of the body, and generalised dystonia affects multiple parts of the body.
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Chronic conditions
Involuntary muscle movements can be caused by a variety of chronic conditions, including:
Tardive Dyskinesia (TD)
TD is a muscle disorder that results from prolonged exposure to certain antipsychotic and neuroleptic medications. It is characterised by repetitive, involuntary movements such as grimacing, lip-smacking, eye blinking, or rapid leg and arm movements. TD can be quite embarrassing for the person experiencing it as it cannot be controlled. It primarily affects older people and may be chronic or permanent.
Myoclonus
Myoclonus refers to sudden, brief involuntary twitching or jerking of a muscle or group of muscles. It is not a disease itself but a clinical sign that can be caused by various factors, including low oxygen levels in the brain (hypoxia), metabolic processes like kidney or liver failure, spinal cord injury, multiple sclerosis, syringomyelia, ischemic myelopathy, trauma to the spine, or infection. Myoclonus can also occur with certain infections, brain tumours, chemical or drug intoxication, lipid storage diseases, autoimmune inflammatory conditions, and COVID-19. It is often associated with nervous system disorders such as multiple sclerosis, epilepsy, and neurodegenerative diseases.
Athetosis
Athetosis describes slow, writhing movements that usually affect the arms and hands. It often causes the body to twist into uncomfortable, unnatural positions. Athetosis is usually associated with chronic conditions like cerebral palsy, Huntington's disease, and Wilson's disease. It is caused by an irregularity in the basal ganglia region of the brain.
Dystonia
Dystonia involves sustained or repetitious muscular contractions, often resulting in abnormal postures. Dystonic storms are acute, generalised dystonic contractions that may include the vocal cords or laryngeal muscles, leading to potentially fatal respiratory obstruction. Dystonia is often caused by certain drugs, including amphetamines, methylphenidate, and cocaine.
Chorea
Chorea is characterised by dance-like, unpatterned movements that often approximate a purpose, such as adjusting clothes or checking a watch. It is often rapid and may involve proximal or distal muscle groups. Chorea can be caused by certain drugs, including amphetamines, methylphenidate, and cocaine.
Rett Syndrome
Rett Syndrome is a rare progressive neurological disorder that causes reduced muscle tone, repetitive hand movements, irregular breathing, developmental delays, gait abnormalities, and seizures. It primarily affects infant girls, with a prevalence of about one in every 10,000 to 23,000 diagnoses.
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Drug reactions
Acute drug-induced movement disorders occur within minutes to days of drug ingestion and include akathisia, tremors, neuroleptic malignant syndrome, serotonin syndrome, and acute dystonic reactions. Akathisia is a common but often under-recognized disorder that can manifest as a sense of internal restlessness, irritability, and tension. Acute dystonic reactions, on the other hand, typically occur in younger patients soon after taking dopamine receptor-blocking drugs and can cause sustained spasms of the craniocervical muscles, oculogyric crises, or limb dystonia.
Subacute drug-induced movement disorders occur within days to weeks of drug ingestion and usually respond to the cessation of the offending drug. Drug-induced parkinsonism, for example, is characterized by bradykinesia, rigidity, and postural instability. Unlike idiopathic Parkinson's disease, drug-induced parkinsonism usually presents as a symmetrical akinetic rigid syndrome and may not respond well to typical antiparkinsonian drugs.
Tardive dyskinesia is a drug-induced movement disorder that develops after prolonged use of medication, typically antipsychotics, anti-nausea medications, and antidepressants. It is characterized by abnormal, uncontrollable, and repetitive movements of the face, limbs, and trunk. Symptoms usually develop after months or years of taking the medication, but they can also occur as early as six weeks in some cases. Females, especially post-menopausal women, older adults, and people of African descent are at a higher risk of developing tardive dyskinesia.
In addition to the above-mentioned drug-induced movement disorders, certain drugs can also cause involuntary muscle movements as a side effect. For example, phenytoin (Dilantin) has been associated with uncontrollable muscle movements, particularly in children and young adults, and high levels or prolonged use may increase the risk. Antimalarials, such as chloroquine, have also been linked to movement disorders, although the reason for this is not yet fully understood.
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Frequently asked questions
Involuntary muscle movements refer to body movements that are outside of one's control. These movements may be mild, such as a slight eye twitch, or quite pronounced, affecting the arms, trunk, or neck.
Involuntary muscle movements can be caused by chronic conditions, nerve damage, drug reactions, or brain injury. They can also be caused by certain medications, metabolic disorders, or neurodegenerative diseases. In some cases, they may be idiopathic, meaning they occur without a known cause.
Treatment for involuntary muscle movements depends on the underlying cause and severity. Medications, such as anti-epileptic drugs, can help reduce the severity of symptoms. Physical therapy and surgery are also potential treatment options. Working with a neurologist or a neurosurgeon can help determine the best course of treatment.
