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Functional Jerks and Twitches - neurosymptoms. Functional myoclonus refers to sudden writing arm movements electric slide or shock like movements that occur as part of a functional movement disorder.
Myoclonus is a symptom found in a wide range of neurological diseases as well as some normal states. Most people have had the experience of jumping or jerking as they are dropping off to sleep. These movements are called 'hypnic jerks'. Most people are also familiar with the random body 'shudder' that some people get.
This is sometimes described as 'walking on someones grave' because of the way it moves quickly through the body.
The occasional hypnic jerk or a body shudder are normal. But in functional myoclonus the jerks become a frequent and disabling problem. There may be jerks of the arms or legs, or quite commonly there is jerking in the body. The movements cannot be controlled ie they are involuntary How does it begin?
Functional myoclonus often begins quite suddenly in around two thirds of cases but may be gradual. It affects patients somewhat later than some of other symptoms described on this website. For example in one series of 35 patients the average age it started was It may follow on from one of the following situations 1.
Functional myoclonus may occur as part of complex regional pain syndrome. Jerks in the trunk commonly accompany back pain.
After experiencing myoclonus from a medical problem such as a.
After having a "fright" or a panic attack 4. With a symptom called ' dissociation ' spaced out or 'zoned out' which can happen without any feelings of fear.
An underlying mild additional cause of myoclonus which has become 'amplified' because of functional myoclonus. How is the diagnosis made?
The diagnosis of functional myoclonus is usually made by a neurologist. It can be difficult diagnosis to make because it requires expert knowledge of the full range of jumps and jerks due to neurological disease, many of which are unusual.
The following are some examples of things a neurologist would look for to diagnose functional myoclonus 1. Jerks of the trunk i. Sudden onset of the condition "out of the blue" with no other obvious disease cause 3.
Flexion jerks of the trunk when walking 5. Jerks which can be suppressed or delayed by the patient using distraction techniques 6. In some research settings the patient can have an investigation called 'EEG jerk-locked back averaging'. This is to look for changes in the brain wave EEG that typically precede the jerk in patients with functional myoclonus.
This change is called a Bereitschaftspotential BP. You can only see this if you record lots of jerks in one individual. This is a difficult investigation to carry out and is more of a research tool than a routine test.
The picture below shows a BP in a patient with functional myoclonus Over half of patients with functional myoclonus describe warning symptoms before some of their jerks. These may last just seconds or sometimes minutes. Some patients describe a rising sense of tension which somehow the jerk gets rid of temporarily.
So they dont want to have the jerk but it is doing something useful, some of the time. Understanding this can be useful in treatment If you don't get any warning then don't be put off by the paragraph above. It doesn't apply to everyone with functional myoclonus.
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