Clonus: Difference between revisions

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=== Clinic ===
=== Clinic ===


* Clonus is a set of involuntary and rhythmic muscular contractions and relaxations.  
* Clonus is a set of involuntary and rhythmic muscular contractions and relaxations which occurs after [[Stretch reflex miasms|Stretch Reflex]].
* It isassociated with [[UMN, Upper Motor Neuron|upper motor neuron]] lesions involving descending motor pathways
* It is associated with [[Upper motor neuron, UMN|upper motor neuron]] lesions involving descending motor pathways
* It is accompanied by [[spasticity]]
* It is accompanied by [[spasticity]]
* Unlike fasciculations, it causes large motions that are usually initiated by a reflex.  
* Unlike [[Fasciculation|fasciculations]], it causes large motions that are usually initiated by a reflex.  
* It is a sign of UMN entity
* It is a [[entity]] of [[Upper motor neuron, UMN|UMN]] series.




=== Cause ===
=== Cause ===
Clonus is typically seen in people with
* [[Cerebral palsy]]
 
* [[CVA|Stroke]]
* Cerebral palsy,
* [[MS, Multiple Sclerosis|Multiple sclerosis]]
* Stroke
* Multiple sclerosis
* Spinal cord damage
* Spinal cord damage
* Hepatic encephalopathy
* Hepatic [[encephalopathy]]
* Epilepsy as part of a generalized tonic–clonic seizure
* [[Seizure|Epilepsy]] as part of a [[Generalized Tonic Clonic Seizures|generalized tonic–clonic seizure]]
* Pre-eclampsia and eclampsia  
* Pre-eclampsia and eclampsia  


== Mechanism[edit] ==
=== Related entities ===
 
=== Hyperactive stretch reflexes[edit] ===
The self re-excitation of hyperactive stretch reflexes theory involves a repetitive contract-relax cycle in the affected muscle, which creates oscillatory movements in the affected limb. In order for self re-excitation to exist, both an increase in motor neuron excitability and nerve signal delay are required. Increased motor neuron excitability is likely accomplished by alterations to the net inhibition of neurons occurring as a result of injury to the central nervous system (CNS) (stroke/ spinal cord injury). This lack of inhibition biases neurons to a net excitatory state, therefore increasing total signal conduction. Signaling delay is present due to an increased nerve conduction time. Long delays are primarily due to long reflex pathways, which are common in distal joints and muscles. This may therefore explain why clonus is typically found in distal structures like the ankle. Frequency of clonus beats have been found to be directly proportional to the length of the reflex pathway it is found in.


=== Central oscillator[edit] ===
* [[Fasciculation|Fasciculations]]: It is sign of [[LMN, Lower Motor Neuron|LMNS]].
Clonus, with respect to the presence of a central oscillator, functions on the theory that when the central oscillator is turned on by a peripheral event, it will continue to rhythmically excite motor neurons, therefore creating clonus.
* [[Myoclonus|Myoclnous]]: It differs from clonus, because of its irregularity.
* [[Spasticity]]: Clonus and Spasticity are co-occurring signs


Although the two proposed mechanisms are very different in [theory] and are still debated, some studies now propose the potential of both mechanisms co-existing to create clonus. It is thought that the stretch reflex pathway may be stimulated first, and through its events, cause a decreased synaptic current threshold. This decreased synaptic current threshold would enhance motor neuron excitability as nerve impulses would be more readily conducted, and thus turn on this central oscillator. This theory is still being investigated.


=== Clonus and spasticity ===
=== Entity / Miasm ===
{| class="wikitable"
!
!EEE/ WEE
!GSS
!JE
!FFI
|-
|Hyper Refexia
| +++
| +++
| +++
| +++
|-
|Tremor
| +++
| +++
| +++
| +
|}


* Clonus tends to co-exist with spasticity in many cases of stroke and spinal cord injury likely due to their common physiological origins
=== Clonus vs Spasticity ===
* Although it is not seen in all patients with spasticity.
* Clonus is not present with spasticity in patients with significantly increased muscle tone, as the muscles are constantly active and therefore not engaging in the characteristic on/off cycle of clonus.


* Previously the co-existance of these two entities has been discovered. But their different identity has been emphasized.
* Now TLT could explain the problem. They are two different entities that share a common symptom, which is Hyper reflexia.
* Spasticity have paralysis and painful spasm but Clonus has tremor.
* So most of patient have both entities but not all since spascity enter the field of hypertonocity and paralysis, and clonus go to trembling


=== Clinic ===
* Clonus is an entity, characterized by series of involuntary, rhythmic, muscular contractions and relaxations.
* Clonus is a classically associated with [[Upper Motot Neuron|UMNS]] involving descending motor pathways
* It is mostly accompanied by another entity named [[spasticity]] 
* Range of frequency is from 3 to 8 Hz on average, and may last a few seconds to several minutes depending on the patient’s condition.
=== Related entities ===
Fasciculations are spontaneous twitches usually caused by [[LMNS, Lower motor neuron syndromes entities|LMNS]]. But clonus causes large motions that are usually initiated by a '''reflex'''.
[[Myoclonous miasms|Myoclonous]]: It differs from clonus, because of its irregularity.




==== Entity/ Miasm ====
{| class="wikitable"
!
!
!CJD
!EEE
!JE
!FFI
!GSS
|-
|
|Hyper Reflexia
| +++
| +++
| +++
| +++
| +++
|-
|Clonus
|Tremor
|
| +++
| +++
| +++
| +++
|-
| rowspan="2" |Spasticity
|Spasm
| +++
|
|
| +++
| +++
|-
|Paralysis
|
| +++
| +++
|
| +++
|}


Related disease
==== Conclusion ====


* CP
* GSS cover both Spasticity and Clonus.
* Stroke
* JE and EEE only cover Clonus
* MS
* Spinal cord damage
* Hepatic encephalopathy
* Serotonin syndrome

Latest revision as of 23:22, 27 September 2023

Clinic

  • Clonus is a set of involuntary and rhythmic muscular contractions and relaxations which occurs after Stretch Reflex.
  • It is associated with upper motor neuron lesions involving descending motor pathways
  • It is accompanied by spasticity
  • Unlike fasciculations, it causes large motions that are usually initiated by a reflex.
  • It is a entity of UMN series.


Cause

Related entities


Entity / Miasm

EEE/ WEE GSS JE FFI
Hyper Refexia +++ +++ +++ +++
Tremor +++ +++ +++ +

Clonus vs Spasticity

  • Previously the co-existance of these two entities has been discovered. But their different identity has been emphasized.
  • Now TLT could explain the problem. They are two different entities that share a common symptom, which is Hyper reflexia.
  • Spasticity have paralysis and painful spasm but Clonus has tremor.
  • So most of patient have both entities but not all since spascity enter the field of hypertonocity and paralysis, and clonus go to trembling


Entity/ Miasm

CJD EEE JE FFI GSS
Hyper Reflexia +++ +++ +++ +++ +++
Clonus Tremor +++ +++ +++ +++
Spasticity Spasm +++ +++ +++
Paralysis +++ +++ +++

Conclusion

  • GSS cover both Spasticity and Clonus.
  • JE and EEE only cover Clonus
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