Introduction
Sudden, involuntary, or jerky movements of the muscles are called myoclonus. These muscle twitches are not self-controllable and can be of four variants that are focal, generalized, multifocal, and segmental in extent. It can affect both adults and children. The occurrence of these tremors can occur at rest or due to abnormal stimulation of muscles.
Despite the many diagnostic aids available, prompt diagnosis of myoclonus is still difficult. Myoclonus can occur due to any disruption in the central nervous system (brain) or spinal cord. It may also occur accompanied by various neuromuscular or neurological disorders. Physiotherapy plays a vital role in managing these jerky or uncontrollable muscle movements.
What Is the Different Classification of Myoclonus?
Neurophysiological Classification of Myoclonus
Myoclonus can be classified into different types based on neurophysiology:
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Cortical Type: It is the most common variant of myoclonus. It usually involves the upper limbs and face. If cortical myoclonus occurs for a longer period, it is referred to as “Epilepsia partialis continua”. These patients can have both positive and negative myoclonus (sudden disruption in muscle function). Seen in Lance Adam syndrome.
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Cortical - Subcortical Type: This variant of myoclonus originates in between the cortex and spinal cord. It is classified into two types:
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Subcortical Non-Segmental Type: It includes the startle reflex and reticular reflex myoclonus. These reflexes are classic examples of brainstem myoclonus.
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Segmental Myoclonus: Tremors in the soft palate (palatal myoclonus) is an example of segmental myoclonus.
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Peripheral Myoclonus: It usually involves the peripheral nervous system (nerve outside the brain and spinal cord) responsible for involuntary jerky movements of the muscles.
Other Types of Myoclonus:
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Action Myoclonus: It usually develops after the brain injury.
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Cortical Reflex Myoclonus: It occurs when only a few muscles are affected involving specific body parts. It is one form of epilepsy currently.
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Essential Myoclonus: It is mostly associated with myoclonus dystonia (movement disorders).
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Palatal Myoclonus: It involves muscles of the soft palate.
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Progressive Myoclonus Epilepsy: It is a rare genetic nerve disorder. It can be seen in cerebral storage disease.
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Sleep Myoclonus: It is characterized by jerky movements of the body that occur only during sleep.
What Are the Causes of Myoclonus?
Myoclonus is most likely caused by:
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Damage to the peripheral nerves.
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Injury to the parts of the central nervous system (brain and spinal cord).
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Pathological tumors involving the brain or other nerves.
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Cerebral hypoxia (oxygen deprivation to the brain for a longer period).
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Metabolic disorders like cerebral storage diseases.
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Neurodegenerative diseases like Parkinson's disease, Alzheimer's disease, multiple sclerosis, etc.
What Are the Signs and Symptoms of Myoclonus Disorder?
Associated signs and symptoms are:
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Muscle Twitches: This is the most common symptom of myoclonus. It can affect any part of the body.
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Shock-like Body Movements: Sudden shock-like movements make a person jump or flinch.
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Weakness and Lethargy: Continuous muscular activities make a person with myoclonus very weak and lethargic.
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Loss of Coordination: Patients affected with myoclonus present with loss of neuromotor coordination, such as difficulty in performing balancing activities like writing, typing, walking, etc.
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Depression and Anxiety: Disturbance in the quality of life; a few patients may end up developing anxiety and depression.
How Does Physiotherapy Help in the Management of Myoclonus?
Physiotherapy exercises under a trained physiotherapist help in managing and relieving symptoms of myoclonus, like triggers of muscle tremors. An occupational therapist helps in performing routine activities like brushing, hairdressing, etc.
Physiotherapists train the patients with different sets of exercises for improvement in muscle strength and flexibility. Various physical exercises for controlling muscle tremors are:
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Muscle Strengthening Training: Trained physiotherapists help to train exercises to the patients for improvement in muscle strength. The type and intensity of exercises are decided by the physiotherapist based on the site and underlying causes of muscle tremor to add the exercises targeting the specific sets of muscles.
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Stretching Exercises: Stretching exercises reduces muscle spasms. Specific sets of stretching exercises are trained for the patient by the physiotherapist based on the area or muscle involved.
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Safe Transfer Techniques Training: Physiotherapists assist patients in performing safe transfer techniques like standing and sitting back on a chair.
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Walking Exercises: The patient is assisted in walking independently or with the use of assisted devices for a few minutes for improvement in balance and muscle coordination.
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Specialized Neck Exercises: In patients with myoclonus due to cerebral ataxia (a genetic disorder affecting the cerebellum of the brain resulting in involuntary muscle movements), special neck exercises are taught to the patients by the certified physiotherapist, such as cervical stabilization exercises or neutral positioning exercises. These exercises help the patient improve motor skills like writing, typing, etc. These exercise programs are scheduled for three days a week for a total of nine weeks. At the end of the training program, the patient usually shows improvement in the postures, balance parameters, and a marked decrease in myoclonus.
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Relaxation Exercises: Relaxation exercises help the patient alleviate pain and muscle tremor. Massage or other manual therapy exercises help to improve blood circulation in the affected areas and decrease the episodes of muscle spasms.
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Rehabilitation Programme: Physiotherapy rehabilitation program by neuro physiotherapist helps patients for early recovery of balance and neuro-muscular coordination of the body.
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Biofeedback: It is a method in which electronic devices are used to monitor muscular activities and provide feedback. These electronic devices are used by the physiotherapist to help the individual with myoclonus to learn muscular activity control.
Along with the physiotherapy exercises, patients should also continue their ongoing medications at the scheduled dose and time as prescribed by the doctor, consume a balanced diet and perform regular exercises for the reduction in the myoclonus episodes and improvement in muscle strength and neuromuscular coordination.
Conclusion
Myoclonus is an uncontrolled muscular movement that can occur for multiple reasons. Myoclonus affects the quality of a person's life by affecting their daily activities. Physiotherapists can help the patient in early recovery and rehabilitation by teaching them different sets of muscle-strengthening exercises and balance improvement exercises. However, early detection of the underlying cause of myoclonus and immediate management are crucial to prevent the worsening of the symptoms and improve quality of life.
