What is the treatment for muscle jerking?

Treatment of Muscle Jerking

Clonazepam is the most effective first-line medication for most forms of myoclonus, with a typical dosage of 0.5-1 mg at bedtime. 1

Diagnosis and Classification

Before initiating treatment, proper diagnosis is essential:

• Myoclonus is characterized by sudden, brief, involuntary jerks caused by muscular contractions or inhibitions 1, 2
• Distinguish from other movement disorders such as tics (which can be temporarily suppressed), dystonia, and seizures 2, 3
• Identify potential triggers such as excitement, frustration, postural changes, sensory stimuli, or specific movements 2
• Determine if the jerking is functional (psychogenic) or organic in nature 3

Pharmacological Treatment

First-Line Therapy

• Clonazepam is recommended as first-line treatment for most forms of myoclonus 1
  • Dosage: 0.5-1 mg at bedtime
  • Beneficial effects typically observed within the first week of treatment
  • May be taken 1-2 hours before bedtime if sleep onset insomnia or morning drowsiness occurs

Alternative Medications

• For functional jerks:

  • General relaxation techniques and sensory grounding strategies 4
  • Addressing unhelpful pre-jerk cognitions and movements 4
  • Combination therapy with tizanidine, baclofen, and clonazepam has shown improvement in some cases 5

• For paroxysmal kinesigenic dyskinesia (PKD):

  • Low-dose voltage-gated sodium channel blockers, especially carbamazepine/oxcarbazepine 1

Non-Pharmacological Approaches

For Functional Jerks

• Encourage learning of 'slow' movement activities such as yoga or tai chi to regain movement control 4
• Implement diaphragmatic breathing or progressive muscular relaxation 4
• Use sensory grounding techniques (noticing environmental details, feeling textured items) 4
• Apply cognitive distractors such as counting backwards and singing 4
• Superimpose alternative, voluntary rhythms to interrupt the jerking pattern 4

For Tremor-Related Jerking

• Assist the person to relax the muscles in the affected limb to prevent cocontraction 4
• Use gross rather than fine movements which require more concentration 4
• Discourage cocontraction or tensing of muscles as a method to suppress tremor 4

Special Clinical Scenarios

Post-Hypoxic Myoclonus

• Status myoclonus starting within 48 hours after cardiac arrest has poor prognosis, but some patients can recover with appropriate treatment 1, 2
• EEG evaluation is recommended to identify awareness and reactivity 1
• Evaluate patients off sedation whenever possible to assess myoclonus severity 1

Dystonia-Related Jerking

• Encourage optimal postural alignment at rest and within function 4
• Promote even distribution of weight in sitting, transfers, standing and walking 4
• Grade activity to increase the time that the affected limb is used within functional activities 4
• Avoid postures that promote prolonged positioning of joints at the end of range 4

Follow-up and Monitoring

• Regular follow-up is necessary to assess treatment efficacy and side effects 1
• Adjust medication dosage based on response and tolerability 1
• Consider EEG monitoring in cases of suspected epileptic myoclonus 1
• For functional jerking, video recording interventions (with consent) can be useful to identify changes in symptoms and demonstrate changeability 4

Caution Regarding Equipment and Aids

• The use of aids and equipment is generally unhelpful in functional neurological disorders 4
• Splinting may prevent restoration of normal movement and function 4
• Potential problems with splinting include increased attention to the affected area, accessory muscle use, compensatory movement strategies, and muscle deconditioning 4