Myoclonus: An Innocent Twitch—or a Serious Illness?

Experiencing bizarre muscle twitches as you fall asleep? Constantly bothered by annoying twitches or spasms in your muscles? You may be suffering from myoclonic jerks or myoclonus. But how worried should you be—and what is myoclonus?

myoclonus

What are the symptoms of myoclonus? One of them is twitching while sleeping, but there are others that cause exhaustion during the day.

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What is myoclonus? According to the National Institute of Neurological Disorders and Stroke, myoclonus “refers to sudden, involuntary jerking of a muscle or group of muscles.” It is a symptom, not a disease, affecting 8.6 people per 100,000 in its more serious presentations. A myoclonic twitch or a myoclonic jerk—when you’re literally twitching while sleeping—may range from hiccups (myoclonus of the diaphragm) to weird leg twitches as you drift into sleep, through to severe rapid-fire twitching of muscles in your leg or face.

In the majority of cases, myoclonus is caused by harmless and temporary nerve dysfunction, which is self-limiting. Rarely, symptoms are severe, recurrent, and disruptive, in which case a medical evaluation may help discover the underlying cause and guide treatment.

Common causes include: medication side effects and neurological or metabolic disorders, but in some, the cause proves frustratingly elusive.

Types of Myoclonus—and Symptoms to Watch

There are two main types of myoclonus:

  • Positive myoclonus (myoclonic jerk or myoclonic twitch), in which there is a burst of spontaneous muscular activity
  • Negative myoclonus, in which there is a silencing of activity

People describe their symptoms as a jerk, twitch, shake, or spasm that is beyond their control, sudden, short-lasting and shock-like. They can vary in intensity from barely noticeable through to multiple severe twitches that interfere with walking, speaking, or eating.

Myoclonic twitches may be localized to one muscle or a group of muscles or they may occur all over the body. If you have myoclonus that is frequent, severe, or persistent, it’s time to seek a medical opinion to rule out an underlying medical problem.

The Causes of Myoclonus

There are many causes of this bizarre symptom. In most cases, myoclonus is physiological and innocent, occurring due to a temporary neurological disturbance.

  • Physiologic myoclonus: This includes hiccups, leg twitches while falling asleep (sleep starts) and twitches or shakes when anxious or overtired.
  • Essential myoclonus: In some people, myoclonus occurs as a lone symptom with no underlying cause; this is known as essential myoclonus. It can run in families (hereditary), but is often random (sporadic). It is usually mild and does not worsen over time.
  • Progressive myoclonus epilepsy (PME): Patients with PME suffer from a range of neurological symptoms including myoclonus and epilepsy, and they may have trouble walking or speaking. These disorders tend to be progressive, worsening over a period of a few months or years.
  • Sleep myoclonus: Many people experience this symptom from time to time—twitching and sometimes a “falling” feeling just as they transition into sleep. It may interfere with the process of falling asleep. Sleep myoclonus can be seen in more serious conditions such as restless leg syndrome.
  • Secondary myoclonus: Myoclonus may occur due to an underlying medical condition that requires treatment from a specialist. Myoclonus may be just one of many symptoms. There are a plethora of causes, including:
  • Nervous system conditions such as head or spinal cord injury, epilepsy (myoclonic seizure), stroke, brain tumor, Alzheimer’s disease, Parkinson’s disease, cerebral palsy, Creutzfeldt-Jakob disease, and many other rare neurological disorders.
  • Infection, especially with fever or sepsis (blood infection).
  • Drug or chemical reactions: Medication, illicit drugs or chemical poisoning. Antihistamines, antidepressants (such as amitriptyline) and opioids (narcotic pain relievers) are most frequently implicated, especially in overdose.
  • Autoimmune inflammatory conditions.
  • Metabolic disorders including low or high blood sugar, calcium, sodium, iron, or magnesium deficiencies.
  • Kidney or liver failure.
  • Prolonged hypoxia (oxygen deprivation), including after a heart attack.

Please note: If your infant or child experiences repeated episodes of myoclonus, it is to essential seek medical advice.

Treatment of Myoclonus

In more serious cases treatment of myoclonus depends on the underlying cause. Existing medications should be reviewed with the prescribing clinician. When no cause is found and the symptoms are bothersome medication can be prescribed to calm the nervous system. These include benzodiazepines (clonazepam) and antiepileptic drugs such as sodium valproate, phenytoin, and levetiracetam.

Such drugs have significant potential side effects, contraindications, and interactions, so their use should be carefully weighed. 5-HT (a serotonin precursor) and sodium oxybate (a narcolepsy drug) may be helpful in some people. When the cause is spinal nerve dysfunction botulinum toxin injections may help relieve severe spasms in individual muscle groups.

For those with mild essential myoclonus, physiological and occasional sleep myoclonus no treatment is needed. You may, however, benefit from tracking triggers, such as caffeine, nicotine, alcohol or antihistamines and then if you see a connection try cutting back on them. Many people also benefit from regular exercise (walking and yoga are excellent), a leg massage or epsom salt bath before bed and a regular sleep schedule. It may also be worth asking your doctor if you would need a blood test, specifically to look for abnormalities in blood sugar, calcium, sodium, iron and magnesium. If levels are abnormal your doctor will recommend medication or supplements.

To learn more about myoclonus and its treatment, visit: The National Institute of Neurological Disorders and Stroke.


Originally published in 2017, this post is regularly updated.

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Comments
  • Sylvia, thank you for reading the article and for your comment. Yes, you are correct, for some causes of myoclonus clonazepam is one of the standard treatments.

    Reply
  • The article mentions several types of muscle spasms, but not those which occur, usually when sleeping or dropping off to sleep and in which the jaws bite the inside of the mouth, leaving permanent injury in the form of blister/cysts which do not go away.

    Reply
  • I have myoclonus for weeks. Thats a serious case isnt it? The weird thing is i fear knowing the real cause and as much as i feel sick, i keep procrastinating a doctor’s appointment. Myoclonus that comes with: palpitations, ice pick headache, wheezing, stiffness in face, hand & leg.

    Reply
  • I “jerk” hard every day, several times a day. Sometimes its my arm, sometimes it’s my legs and sometimes it’s my neck/ head. And this is while I am wide awake. If I have anything in my hands, it goes flying across the room. It has almost thrown me out of my chair. What are your thoughts on this and should I go see a Dr. at this time?

    Reply
  • Terri S. I would definitely see your doctor, they will be able to examine you and maybe run some tests. Whatever is going on, its best to find out sooner rather than later. Best wishes.

    Reply
  • My body jerks / twitches mostly when I am lying down. Never a problem when I am walking, standing up, or when I am out for a run. Its kind of odd???

    Reply
  • My husband has Parkinson’s, and severe neuropathy. He is also on hemo dialysis. He’s on Carbidopa/Levodopa, Tramadol, and Gabapentin. Also on Plavix, Isosorbide Dinitrate and low dose aspirin as he recently had a TAVR and pacemaker installed. Heart is very strong now. He is experiencing severe body jerks (worse than the usual tremors). His Cardiologist suggested 1/2 ink the isosorbide dinitrate, and reduce Gabapentin. He can’t miss a single dose of his Tramadol or the pain in his legs goes to a 9-10 level. I know he’s a very complicated case but any ideas? The body jerks are bad and his balance and equalibrium are very bad.

    Reply
  • I’m in dire need of help myself. My myoclonic jerk’s send me jerking untill I collapse on the ground landing hard, left unable to move any part of my body and unable to speak. I have fibromyalgia, herniated discs in back and my neck which I have a pinched nerve that runs from my neck through my shoulder down my arm and into my thumb and index finger with a great deal of pain. I was put on gabapentin almost 2 years ago to take along with the pain medicine that I’ve been on for numerous years. I cut my gabapentin down to 400 mg. from 800 mg. trying to keep these episodes from occuring which has not helped. I’ve talked to my family Dr , paint Dr , and 2 different neurologist that don’t seem to have any clue how to help me or what to look for to solve my condition. I seem to find out more on the internet than they even seem to know. Please help. This is causing me to not be able to function at any type of life. What do I do?????

    Reply
  • Thanks for reading this article and taking the time to comment. Unfortunately we’re unable to give personalized advice, but would recommend you see your doctor or perhaps seek a second opinion if you’re unhappy.

    Reply
  • As a person that had the onset of Myoclonus Dystonia at age 8 and have lived with it for 52 years, your article is suspiciously under researched. You give an impression that this”Condition” is equivalent to hiccups. What are you some conservative retarded think tank. This is a disease not a condition. It can affect every single aspect of life. Years of living with this disease leads to all the Psychiatric disorders as well as constant anxiety and severe recurring depression.
    Fortunately I am Canadian, and far more research has been done by both the Canadian Health Care system and the National Health Services In United Kingdom.
    Those reading this, read the research done in more aggressive countries that see health as it relates to quality of life and not the the thickness of the wallet.

    Reply
  • To the Canuck, that health care system is one of the worst in the open world, all the good/great doctors are in the States making a living, you live in an altered state of reality, the world is what it is, not what you would like it to be….come to the states to get treated properly.. The best healthcare and doctors On The Planet PERIOD!!!!

    Reply
  • I have experienced severe twitching?cramping in my legs for 51 years, since I was a child. It has never been diagnosed. Quinine as the treatment in Peru, but the doctors stateside wouldn’t prescribe it. Neurological tests come out “normal” and the drs never seem interested in exploration. My symptoms tend to be bilateral now and are starting to impact my extremities. No rhyme or reason to what sets me off. What was your diagnosis as a child?

    Reply
  • Okay….both of you calm down. To the US citizen: Just because our health care is expensive in the US, does not mean its because of its effectiveness. It just means we live in a developed country with more access to (disproportionate) wealth, which means more access to sanitation, which means less complications during routine health care procedures. Just because the universities that are located elsewhere are free, does not make them less effective. It just makes them more feasible, meaning more doctors, meaning more access to health care. In regards to the Canadian person: Agreed that the US health care system and research is often almost always influenced by lobbyists and internationally, tends to be more accurate and resulting in successful or satisfying levels of care, but educate yourself on the language you use. Calling someone the “r” word, doesn’t exactly make you seem like a credible source of information.

    Reply
  • Gluten Ataxia & Celiac Disease should be listed as possible causes. Though technically they are covered under “Autoimmune inflammatory conditions,” few people are aware that both Celiac Disease & Gluten allergies can cause myoclonus along with a host of other neurological symptoms such as cerebral ataxia. I am just now figuring this out. Furthermore, patients with a Gluten Allergy (not celiac) who present with neurological symptoms typically DO NOT present with gastrointestinal symptons.

    To eliminate Gluten allergies as a possible cause of your myoclonus, your doctor needs to run all three gluten antibody tests. Then, if positive, they will possibly need a GI tract biopsy, but if you are presenting with neurological symptoms, the biopsy can come back negative.

    – Gluten Sensitivity – A Potentially Reversible Cause of Progressive Cerebellar Ataxia and Myoclonus – A Case Report (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4668456/)
    – Myoclonus ataxia and refractory coeliac disease (https://cerebellumandataxias.biomedcentral.com/articles/10.1186/2053-8871-1-11)

    Reply

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