Is There A Surgery For Myoclonus?

The sudden involuntary twitching or jerking of muscles is known as myoclonus and it can be treated in various ways. However, in most incidences, patients usually recover from the condition unscathed without treatment. Myoclonus is linked to the several causes, with the background being a neurological defect in the brain. So, in one way or the other, myoclonus can be treated by trying to rectify the underlying defect.

Myoclonus is classified as either; cortical myoclonus, cortical-subcortical myoclonus, subcortical-nonsegmental myoclonus, segmental myoclonus or peripheral myoclonus, depending on the inflicted areas. For instance, cortical myoclonus, which is the most common, is associated with the cerebral cortex and affects the upper limbs and face. Subcortical-nonsegmental myoclonus on the other hand is more variable due to the many possible sites, nuclei and neuronal circuits that can lead to muscle jerking.1

Is There A Surgery For Myoclonus?

Is surgery viable for myoclonus? In general, surgery is not the first approach to treating myoclonus. However, in some cases, with regards to the form of myoclonus a patient is suffering from and its intensity, surgery can be considered. It is important that you are aware that myoclonus often occurs as a symptom of an underlying condition. This means that if you are diagnosed with myoclonus, you might also be suffering from another condition for example; myoclonus dystonia and progressive myoclonic epilepsy.

Myoclonus dystonia falls under the subcortical-nonsegmental myoclonus. It is characterized by startle responses and contraction of agonistic and antagonistic muscles that interfere with posture. In patients with myoclonus dystonia, the causes of the symptoms have been linked to the brainstem, palladium, thalamus, and neocortex of the brain. Surgery comes in whereby, depending on the affected region of the brain, stimulation can be induced to get rid of the muscle jerking. A pallidal stimulation for example has been known to relieve myoclonus dystonia. The surgery can be carried out by implanting electrodes in the internal Globus pallidus and applying deep brain stimulation. Depending on the degree of myoclonus, this surgery can be done in two phases, each hemisphere of the brain at a time.

For patients suffering from progressive myoclonic epilepsy, the surgery is a little bit different. Instead of the electrode being attached to the internal Globus pallidus, the targeted region is the substantia nigra pars reticulate or subthalamic nucleus. The origin of myoclonus jerks in patients with progressive myoclonic epilepsy has been associated with the cortical and subcortical parts of the brain. The most common symptoms of this condition include difficulties in speech and walking. According to studies where patients with progressive myoclonic epilepsy have been subjected to deep brain stimulation on the substantia nigra pars reticulate or subthalamic nucleus, the procedure has been successful. Needless say, the patients have shown tremendous recovery.

Understanding Various Classifications Of Myoclonus

As earlier mentioned, myoclonus can arise due to neurological defects in the brain. Therefore, myoclonus has been classified with respect the regions of the brain it is associated with. These classifications are; cortical myoclonus, cortical-subcortical myoclonus, subcortical-nonsegmental myoclonus, segmental myoclonus or peripheral myoclonus. Cortical myoclonus is associated with the cerebral cortex; cortical-subcortical myoclonus is linked to seizure phenomena’s that arise from spasmodic abnormal excessive oscillations in bidirectional connections between cortical and subcortical structures.

Subcortical-nonsegmental myoclonus involves a burst of extreme activities that may arise and be transmitted to descending motor pathways. The most common regions associated with this myoclonus are the neocortex, thalamus, palladium, and brainstem. Segmental myoclonus is connected to a particular segment or adjoining segments of the brainstem and/or spinal cord. Therefore, the cause of such myoclonus can be located at a focal point. The peripheral myoclonus is as a result of muscle jerks related to a peripheral site.

Conclusion

Surgery can be seen as a more effective treatment approach to improving lives of myoclonus patients. This is because it directly targets the affected brain region and through deep brain stimulation, helps reduce the myoclonus muscle twitches. In successful cases, movement can be restored and patients who had been seriously afflicted are able to run their daily activities with ease.

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