Experts mean some of the body's responses to external stimuli.
A classic example is the knee-jerk reflex, in which the patient is asked to cross his legs so that one knee is over the other, and then suddenly a light blow is applied to the dimple under the patella.
The correct reaction of the body in this case is to straighten the leg, which helps maintain balance and posture.
Reflex distortions: from increasing to decreasing
Deviations from the norm include hyperreflexia (increased reflex), in which in the given example the leg will straighten to the maximum, or hyporeflexia (decreased reflex), expressed in a weak reaction to an external stimulus, as well as in the complete absence of it.
In both cases, such distortions in the body’s response are evidence of changes in the nervous system. If the reflexes are reduced, then, most likely, the integrity and conductivity of the reflex arc is impaired in one of its three sections - efferent, associated or afferent.
While their excess signals increased reflex activity on the part of the spinal cord. As a rule, this is a consequence of the pathology of the pyramidal tracts, through which the cerebral cortex transmits inhibition to the spinal mechanisms.
Pyramid Path
Clonus and its causes
Extreme manifestations of hyperreflexia are expressed in the rhythmic alternation of tendon reflexes, and are called clonus. When using this term, they most often mean rapid, jerky contractions of the muscles of the foot or kneecap. In addition, clonus of the toes and hands, mandible, buttocks, or forearm may be observed. 
The causes of this syndrome vary. So, if clonus occurs spontaneously, then, as a rule, we can talk about, or diseases such as or.
Sometimes clonus occurs due to external irritants, accompanying diseases such as, or. Having become a reaction to a single stretch of the tendon, clonus is expressed in multiple contractions of parallel muscles, and in this case it is difficult to predict the duration of this process.
If the twitching movements of the kneecap or feet are not characterized by rhythm or quickly fade away, this most likely indicates pseudoclonus, characteristic of.
On the contrary, long-term stereotypical muscle contractions, characteristic of true clonus, along with muscle spasticity, increased tone, tendon and periosteal reflexes, are symptomatic of such a pathological condition as central paralysis.
Diagnostic mechanism
Clonus of the patella is characterized by its sharp downward displacement, while it retains its position even if it is pulled back. In order to provoke this altered reflex, the patient is asked to assume a horizontal position and straighten his legs.
After this, the doctor grabs the kneecap with two fingers - the thumb and forefinger, moves it down and holds it in this position. The tendon is stretched, causing the muscles to involuntarily contract and the kneecap to twitch rhythmically.
To provoke foot clonus, the patient must also be placed on the couch and his leg should be bent at the knee and hip with one hand, and his foot should be grabbed with the other, sharply bent and straightened. Stretched, the Achilles tendon will provoke uncontrolled rhythmic movements of the foot, reminiscent of twitching.
It is worth emphasizing that both of the above examples of altered reflexes indicate disorders of the nervous system. But still, one of the most unfavorable situations is an uneven increase in reflexes (the so-called anisoreflexia), in which the left and right halves of the body react to the stimulus with different degrees of intensity.
Unlike a symmetrical increase in reflexes, which does not always mean that this is a sign of brain damage, their unevenness is an alarming symptom. As a rule, this is possible in two cases: inhibition of the reflex on one side, associated with damage to the reflex arc in the nerve, roots or gray matter of the spinal cord, or its activation on the other (which indicates damage to the pyramidal tract).
Foot clonus in practice looks like this:
Further research and treatment
Changes in reflexes can be thoroughly examined using modern diagnostic methods such as, and.
To record electrical impulses of neurons, a. And in order to evaluate the electrical potentials of skeletal muscles -. In addition, blood and cerebrospinal fluid tests will help establish a complete picture of the disease.
After the entire range of diagnostic studies has been carried out, the specialist will prescribe a treatment regimen depending on the characteristics of the underlying disease.
Most often, patients with pyramidal and extrapyramidal disorders are shown drugs that relax muscles and also support normal metabolism in nerve cells.
It should be noted that when treating this group of diseases, one cannot do without balneotherapy and physiotherapy, physical therapy and acupressure; a positive effect will also be noticeable from sessions with a psychologist.
An integrated approach to solving pyramidal and extrapyramidal disorders can significantly slow down the progression of their pathological manifestations. However, there is no favorable prognosis, and maintenance therapy should be constant.
To prevent clonus, which in the most severe cases indicates paralysis, it is necessary to give up bad habits, careful treatment, and constantly measure and monitor blood pressure. 
In addition, the state of the nervous system is well influenced by adherence to a healthy lifestyle, expressed in long walks, good sleep and regular exercise, as well as proper nutrition and a varied diet.
You should know that the nervous system is well strengthened by B vitamins, and do not forget to take them periodically.
So, clonus is the maximum possible reaction of the body to an external influence, expressed in rapid involuntary muscle contractions, which, under certain conditions, is characteristic of the kneecaps and feet. As a rule, this increase in reflex is a symptom of a serious pathology of the nervous system, so it is important to identify it as early as possible, and then begin to diagnose and treat the underlying disease.
An extreme manifestation of increased tendon reflexes are the so-called clonus. Clonus are rhythmic contractions of a muscle resulting from stretching of its tendon. In essence, clonus is a chain of tendon reflexes following one another, caused by continuous stretching of the tendon. The most common are clonus of the kneecap and foot.
Patella clonus is caused by a sudden downward displacement of the kneecap, while the retracted kneecap continues to be held in a displaced position. The subject lies on his back with his legs straightened. The kneecap is grasped by the thumb and forefinger of the examiner and jolted downwards.
The m. tendon is stretched. quadricipitis, which attaches the muscle to the upper edge of the bursa of the kneecap, which with a very high knee reflex is sufficient to cause contraction of the muscle, the stretching of the tendon does not stop, and muscle contractions follow one after another, causing the rhythmic movement of the kneecap.
Foot clonus is also caused in the supine position of the patient. With the right hand, the foot is grabbed by its distal part, the leg is bent at the knee and hip joints, and with a sharp push the foot is extended at the ankle joint. As a result of stretching the Achilles tendon, rhythmic movements of flexion and extension of the foot occur (with an extreme degree of vivacity of the Achilles reflex).
Since clonus of the kneecap and foot are only indicators of a significant increase in the knee and Achilles reflexes, they can be observed in all cases of hyperreflexia, including those not with organic damage to the nervous system. Unlike organic clonus, clonus with neuroses, physiological increase in reflexes, etc. usually not persistent enough, always evenly expressed on both sides and not accompanied by other organic symptoms.
Clonus on the upper extremities are rarely observed; more often than others there is clonus of the hand, which occurs as a result of a sharp jerky extension of it.
If a symmetrical decrease or increase in reflexes is not always a sign of damage to the nervous system, then their unevenness always indicates an existing organic disease. Unevenness of reflexes (anisoreflexia) occurs either as a result of a decrease in reflexes on one side (damage to the reflex arc in the nerve, roots or gray matter of the spinal cord), or an increase in it on the other (damage to the pyramidal tract).
Establishing the unevenness of reflexes is therefore extremely important. Therefore, they must be examined carefully, using hammer blows, line stimulation, etc. must be applied accurately and be of equal strength when examined on the right and left; it is advisable not to be limited to a single examination, to evoke reflexes using different methods, etc.
“Topical diagnosis of diseases of the nervous system”, A.V.Triumfov
Flexion-ulnar, or reflex from the tendon m. bicipitis, is caused by a hammer hitting the biceps tendon in the elbow. The response is contraction of the named muscle and flexion at the elbow joint. Reflex arc: n. musculocutaneus, V and VI cervical segments of the spinal cord. Deep, tendon reflex. To evoke it, the examiner takes the hands of the person being examined with his left hand and bends it...
In order to judge the normal electrical excitability of nerves and muscles or to establish certain deviations from the norm, it is necessary to know the average values of electrical excitability obtained from a study of a large number of healthy individuals. In the process of studying electrical excitability, it was found that contraction is most easily obtained from certain areas of nerves and muscles, from the so-called motor points, or points...
The metacarpal-radial, or carporadial, reflex is caused by a hammer blow on the processus styloideus of the radius and consists of flexion at the elbow joint, pronation and flexion of the fingers. Not all of the above reactions are obtained all the time: pronation is usually most clearly expressed. When inducing a reflex, the arm of the subject should be bent at a right or slightly obtuse angle at the elbow joint, the hand should be in the middle...
Random clonic convulsions are rhythmic movements associated with epileptic seizures, hyperkinesis, and diseases of the extrapyramidal system. They look like jerky twitches of the lower leg, occurring from an involuntary contraction of a muscle or group of muscles. The name “clonus” is taken from the Greek language, from the word “κλόνος”, which is translated into Russian as turmoil, hustle and bustle.
Methods for detecting pathology
The doctor can cause clonus of the patella in a patient who lies on his back with straight legs. The doctor takes the top of the patella with two fingers, pulls it up, then quickly releases it. A possible reaction of the body to such a motor test is rhythmic contractions of the quadriceps femoris muscle, twitching of the patella. The test confirms the presence of disturbances in the pyramidal tract.
On the foot, the physician checks for clonus by supporting the patient's leg under the knee while the patient lies flat on his back. With one hand, the doctor lifts the leg so that it bends slightly at the knee, with the other hand he firmly grasps the foot and bends it to the back with a sharp movement. This action causes tension in the Achilles tendon. If, after stretching, a rhythmic twitching of the foot begins, this is clonus.
Normally there should be no clonus. Its manifestation is a significant reason for studying the functioning of the central nervous system. Both ways of testing for changes in reflexes indicate CNS dysfunction.
What is knee clonus
Involuntary muscle contractions in a certain rhythm occur due to the impact on the tendon ending. Most often, a person experiences clonus of the feet and kneecaps, caused by tension in the tendon. Such reactions indicate an excess of the knee and Achilles reflexes. They manifest themselves in any situation of hyperreflexia with dysfunctions of the central nervous system of an inorganic nature.
Clonus of an inorganic nature differ from reflexive disorders based on lesions of an organic type or arising against the background of neuroses. They are characterized by insufficient stability and uniform bilateral expression.
If the clonus are not uniform and symmetrical, this indicates an organic disease in the central nervous system. The uneven manifestation of reflexive responses to external stimulation is called anisoreflexia. It is caused by a unilateral decrease or increase in reflexes.
Unilateral decrease - hyporeflexia - indicates damage to the neural arch of reflexes. A one-sided increase in reflexes—hyperreflexia—indicates damage to the pyramidal chain through which inhibitory impulses must pass. To identify reflex unevenness, doctors use irritation with a needle or hammer blows.
Clonus in various somatic disorders
The pathophysiology of clonus in pyramidal chain dysfunction is manifested in the absence of an inhibitor coming from the cerebral cortex to the motor neurons of the spinal cord. Without an inhibitory impulse, reflex excitation lasts a long time, which is why involuntary muscle twitches are repeated.
In epilepsy, clonic convulsions manifest themselves in sequential contraction of the flexion and extension muscles, in rapid involuntary movements of the leg. The epileptic nature of clonus also occurs in infants, when in a dream the baby involuntarily twitches its legs for a minute or two. It is recommended to contact an experienced neurologist and begin a targeted examination.
EEG monitoring is the most informative for a doctor when the baby is put on a special “hat” with sensors in which he must sleep. The sensors are connected to a computer, which records manifestations of knee clonus. If abnormalities in the functions of the central nervous system are confirmed, the doctor prescribes treatment for the child.
Knee Reflex Diagram
Foot clonus in an infant indicates muscle hypertonicity, which manifests itself due to intracranial hypertension. The tendon reflex increases in newborns with suspected cerebral palsy, porencephaly, microgyria, and gliomatosis. However, clonus of the knees and feet in children in the first days of life may manifest itself as a transient physiological phenomenon. In this case, it is not accompanied by other pathology.
Neurotic disorders are characterized by pseudoclonus: twitching of the cup or foot is not rhythmic and quickly fades away. True clonus is characterized by prolonged stereotypical twitching of the feet and legs, high general tone, which usually indicates central paralysis. A separate phenomenon is myoclonus - a single impulse startle. It occurs due to active muscle contraction, which occurs in many people at the moment of falling asleep.
Involuntary twitching while falling asleep is not a harmless indicator of the release of daytime stress, but a symptom of many central nervous system diseases. Generalized clonus is observed in epilepsy, during seizures accompanied by convulsions and loss of consciousness.
Causes of the disease
If clonus occurs spontaneously, the doctor suspects epilepsy or a nervous tic. If clonus occurs due to external irritations, the causes may be: meningitis, encephalitis, stroke, tumors in brain structures, head injuries.
Clonus is caused by rare diseases:
- Huntington's chorea;
- hyperkinesis;
- hemiballismus;
- myoclonus;
- tremor;
- psychoneurological disorders.
All these diseases are accompanied by disturbances in the functioning of the pyramidal system. The main cause of clonus caused by external stimuli is pyramidal chain diseases of the inflammatory, degenerative, and vascular types.
Symptoms
Involuntary movements of the human body are controlled by the extrapyramidal chain. Its defeat leads to a decrease in muscle tone, causing movement disorders. They manifest themselves as twitching of the leg, kneecap, or foot. When diagnosing neurosis, the doctor takes into account that clonus is a false phenomenon, but notes its presence in the patient’s medical history. Clonus in such a situation manifests itself with irregular rhythm and passes quickly.
The pyramidal pathway supports the coordination of complex movements. When the pyramidal tract is damaged, paresis, paralysis, and impaired reflexes occur, which include clonus of the feet and knees.
Diagnostic and treatment measures
Electromyography is performed to assess muscle potential
MRI, ultrasound, and CT help to study reflexive response dysfunction. To record the impulse passage of neurons to assess the state of the central nervous system, the doctor prescribes an EEG. The potentials of the skeletal muscles are perfectly assessed by electromyography. The examination is complemented by blood and spinal fluid tests.
Comprehensive diagnostics allows the doctor to choose the direction of therapy in accordance with the identified disorders. In case of disorders of the pyramidal and extrapyramidal tracts, drugs are prescribed to relax muscles, protect nerve fibers, support brain functions, and maintain metabolism at the cellular level. Treatment is carried out in combination with physiotherapy, massage, acupuncture, exercise therapy.
Patients who exhibit pyramidal and extrapyramidal dysfunctions are forced to constantly take maintenance medications. Comprehensive medication and physical procedures relieve pathological symptoms, but doctors do not give anyone a favorable prognosis.
The doctor can cause clonus of the patella in a patient who lies on his back with straight legs. The doctor takes the top of the patella with two fingers, pulls it, then quickly releases it. A possible reaction of the body to such a motor test is rhythmic contractions of the quadriceps femoris muscle, twitching of the patella. The test confirms the presence of disturbances in the pyramidal tract.
On the foot, the physician checks for clonus by supporting the patient's leg under the knee while the patient lies flat on his back. With one hand, the doctor lifts the leg so that it bends slightly at the knee, with the other hand he firmly grasps the foot and bends it to the back with a sharp movement. This action causes tension in the Achilles tendon. If, after stretching, a rhythmic twitching of the foot begins, this is clonus.
Normally there should be no clonus. Its manifestation is a significant reason for studying the functioning of the central nervous system. Both ways of testing for changes in reflexes indicate CNS dysfunction.
What is knee clonus
Detection of clonus by palpation and inspection
Involuntary muscle contractions in a certain rhythm occur due to the impact on the tendon ending. Most often, a person experiences clonus of the feet and kneecaps, caused by tension in the tendon. Such reactions indicate an excess of the knee and Achilles reflexes. They manifest themselves in any situation of hyperreflexia with dysfunctions of the central nervous system of an inorganic nature.
Clonus of an inorganic nature differ from reflexive disorders based on lesions of an organic type or arising against the background of neuroses. They are characterized by insufficient stability and uniform bilateral expression.
If the clonus are not uniform and symmetrical, this indicates an organic disease in the central nervous system. The uneven manifestation of reflexive responses to external stimulation is called anisoreflexia. It is caused by a unilateral decrease or increase in reflexes.
Unilateral decrease - hyporeflexia - indicates damage to the neural arch of reflexes. A one-sided increase in reflexes—hyperreflexia—indicates damage to the pyramidal chain through which inhibitory impulses must pass. To identify reflex unevenness, doctors use irritation with a needle or hammer blows.
Clonus in various somatic disorders
The pathophysiology of clonus in pyramidal chain dysfunction is manifested in the absence of an inhibitor coming from the cerebral cortex to the motor neurons of the spinal cord. Without an inhibitory impulse, reflex excitation lasts a long time, which is why involuntary muscle twitches are repeated.
In epilepsy, clonic convulsions manifest themselves in sequential contraction of the flexion and extension muscles, in rapid involuntary movements of the leg. The epileptic nature of clonus also occurs in infants, when in a dream the baby involuntarily twitches its legs for a minute or two. It is recommended to contact an experienced neurologist and begin a targeted examination.
EEG monitoring is the most informative for a doctor when the baby is put on a special “hat” with sensors in which he must sleep. The sensors are connected to a computer, which records manifestations of knee clonus. If abnormalities in the functions of the central nervous system are confirmed, the doctor prescribes treatment for the child.
Knee Reflex Diagram
Foot clonus in an infant indicates muscle hypertonicity, which manifests itself due to intracranial hypertension. The tendon reflex increases in newborns with suspected cerebral palsy, porencephaly, microgyria, and gliomatosis. However, clonus of the knees and feet in children in the first days of life may manifest itself as a transient physiological phenomenon. In this case, it is not accompanied by other pathology.
Neurotic disorders are characterized by pseudoclonus: twitching of the cup or foot is not rhythmic and quickly fades away. True clonus is characterized by prolonged stereotypical twitching of the feet and legs, high general tone, which usually indicates central paralysis. A separate phenomenon is myoclonus - a single impulse startle. It occurs due to active muscle contraction, which occurs in many people at the moment of falling asleep.
Involuntary twitching while falling asleep is not a harmless indicator of the release of daytime stress, but a symptom of many central nervous system diseases. Generalized clonus is observed in epilepsy, during seizures accompanied by convulsions and loss of consciousness.
Causes of the disease
If clonus occurs spontaneously, the doctor suspects epilepsy or a nervous tic. If clonus occurs due to external irritations, the causes may be: meningitis, encephalitis, stroke, tumors in brain structures, head injuries.
Clonus is caused by rare diseases:
- Huntington's chorea;
- hyperkinesis;
- hemiballismus;
- myoclonus;
- tremor;
- psychoneurological disorders.
All these diseases are accompanied by disturbances in the functioning of the pyramidal system. The main cause of clonus caused by external stimuli is pyramidal chain diseases of the inflammatory, degenerative, and vascular types.
Symptoms
Involuntary movements of the human body are controlled by the extrapyramidal chain. Its defeat leads to a decrease in muscle tone, causing movement disorders. They manifest themselves as twitching of the leg, kneecap, or foot. When diagnosing neurosis, the doctor takes into account that clonus is a false phenomenon, but notes its presence in the patient’s medical history. Clonus in such a situation manifests itself with irregular rhythm and passes quickly.
The pyramidal pathway supports the coordination of complex movements. When the pyramidal tract is damaged, paresis, paralysis, and impaired reflexes occur, which include clonus of the feet and knees.
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Causes
Although researchers do not understand the exact reasons that cause clonus, it appears to be related to damaged nerve connections in the brain.
A number of chronic diseases are associated with clonus. Because these diseases require specialized treatment, results may vary in each case.
Diseases that can cause clonus:
- Multiple sclerosis is an autoimmune disorder that attacks the protective sheath around the nerves. The resulting damage disrupts nerve signals in the brain.
- Stroke - due to a blood clot, part of the brain is starved of oxygen. A stroke can cause clonus if the area of the brain that controls movement is damaged.
- Infections such as meningitis or encephalitis can damage brain cells or nerves in advanced cases.
- Serious injuries, such as head trauma from a major accident, can also damage nerves in the brain or spinal cord.
- Serotonin syndrome is a potentially dangerous reaction that occurs when too much serotonin accumulates in the body. This buildup can be caused by drug abuse, but can also be caused by using high doses of medications or mixing certain medications.
- A brain tumor can also cause clonus.
Other causes of clonus include anything that can affect nerves or brain cells:
- epilepsy;
- cerebral paralysis;
- Lou Gehrig's disease;
- anoxic brain injury;
- hereditary spastic paraparesis;
- renal or liver failure;
- overdoses of drugs such as the synthetic opiate tramadol, which is a powerful painkiller;
Diagnostics
To diagnose clonus, doctors may first physically examine the most affected area. If a muscle contracts while a person is in the doctor's office, they can monitor the contraction to see how quickly the muscle pulsates and how many times it contracts before it stops.
Doctors then order a series of tests and tests to confirm the diagnosis. They may use magnetic resonance imaging (MRI) to check for cell or nerve damage.
Blood tests can also help identify markers of various conditions associated with clonus.
A physical test can also help doctors identify clonus. During this test, the patient is asked to quickly flex the leg so that the toes are pointing and then hold the muscles. This can cause prolonged throbbing in the ankle. A number of these pulses may indicate clonus. This may not be the basis for making a diagnosis, but it can help guide the diagnostic process in the right direction.
Treatment
Treatment for clonus varies depending on the underlying cause. Doctors may try many different treatments before finding the one that works best for a particular patient.
Medications
Sedatives and muscle relaxants help reduce symptoms. Doctors often recommend these drugs primarily for people experiencing cloning.
Medications that may help with clonus reduction include:
- Baclofen;
- Dantrolene;
- Tizanidine;
- Gabapentin;
- Diazepam;
- Clonazepam.
Sedatives and antispastic drugs may cause drowsiness. Patients taking these medications should not drive or operate heavy machinery.
Other side effects may include mental confusion, lightheadedness, or even trouble walking. You should discuss these side effects with your doctor, especially if they may interfere with daily activities.
Physiotherapy
Working with a physical therapist to train muscles can help increase range of motion in the injured area.
Botox injections
Some people respond well to clonus to Botox injections. Botox therapy involves the injection of certain toxins. The effects of Botox injections wear off over time, so a person will need repeat injections on a regular basis.
Surgery
Surgery is often the last resort. During a procedure to treat clonus, surgeons will cut off parts of the nerve that are causing the abnormal muscle movements, which should relieve symptoms.
Home Remedies
While medical treatments, home remedies may be helpful to support these efforts.
Using heat packs or using warm baths can relieve pain, and using cold packs can help reduce muscle pain. Stretching and yoga can help increase your range of motion.
You can use a magnesium supplement or a magnesium salt bath to help relax your muscles. You should consult your doctor before using magnesium as it may interact with other medications.
Forecast
Clonus has a different prognosis depending on the underlying cause. If a sudden injury or illness causes clonus muscle spasms, symptoms will likely subside over time or respond well to physical therapy.
Chronic diseases such as multiple sclerosis, meningitis or stroke may require long-term management of symptoms. Clonus may worsen as the underlying condition progresses.
The article was written based on materials from the Medical News Today website.
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+Reflex distortions: from increasing to decreasing
Deviations from the norm include hyperreflexia (increased reflex), in which in the given example the leg will straighten to the maximum, or hyporeflexia (decreased reflex), expressed in a weak reaction to an external stimulus, as well as in the complete absence of it.
In both cases, such distortions in the body’s response are evidence of changes in the nervous system. If the reflexes are reduced, then, most likely, the integrity and conductivity of the reflex arc is impaired in one of its three sections - efferent, associated or afferent.
While their excess signals increased reflex activity on the part of the spinal cord. As a rule, this is a consequence of the pathology of the pyramidal tracts, through which the cerebral cortex transmits inhibition to the spinal mechanisms.
Pyramid Path
Clonus and its causes
Extreme manifestations of hyperreflexia are expressed in the rhythmic alternation of tendon reflexes, and are called clonus. When using this term, they most often mean rapid, jerky contractions of the muscles of the foot or kneecap. In addition, clonus of the toes and hands, mandible, buttocks, or forearm may be observed. 
The causes of this syndrome vary. So, if clonus occurs spontaneously, then, as a rule, we can talk about epilepsy, or diseases such as nervous tics or tremor.
Sometimes clonus occurs due to external irritants, accompanying diseases such as meningitis, encephalitis, stroke, brain tumors or traumatic brain injury. Having become a reaction to a single stretch of the tendon, clonus is expressed in multiple contractions of parallel muscles, and in this case it is difficult to predict the duration of this process.
If the twitching movements of the kneecap or feet are not characterized by rhythm or quickly fade away, this most likely indicates pseudoclonus, which is characteristic of neurosis.
On the contrary, long-term stereotypical muscle contractions, characteristic of true clonus, along with muscle spasticity, increased tone, tendon and periosteal reflexes, are symptomatic of such a pathological condition as central paralysis.
Diagnostic mechanism
Clonus of the patella is characterized by its sharp downward displacement, while it retains its position even if it is pulled back. In order to provoke this altered reflex, the patient is asked to assume a horizontal position and straighten his legs.
After this, the doctor grabs the kneecap with two fingers - the thumb and forefinger, moves it down and holds it in this position. The tendon is stretched, causing the muscles to involuntarily contract and the kneecap to twitch rhythmically.
To provoke foot clonus, the patient must also be placed on the couch and his leg should be bent at the knee and hip with one hand, and his foot should be grabbed with the other, sharply bent and straightened. Stretched, the Achilles tendon will provoke uncontrolled rhythmic movements of the foot, reminiscent of twitching. 
It is worth emphasizing that both of the above examples of altered reflexes indicate disorders of the nervous system. But still, one of the most unfavorable situations is an uneven increase in reflexes (the so-called anisoreflexia), in which the left and right halves of the body react to the stimulus with different degrees of intensity.
Unlike a symmetrical increase in reflexes, which does not always mean that this is a sign of brain damage, their unevenness is an alarming symptom. As a rule, this is possible in two cases: inhibition of the reflex on one side, associated with damage to the reflex arc in the nerve, roots or gray matter of the spinal cord, or its activation on the other (which indicates damage to the pyramidal tract).
Foot clonus in practice looks like this:
Characteristics of the disease
According to some estimates, hyperexcitability in infants is diagnosed in more than 40% of children born. The attitude towards this phenomenon in different countries is ambiguous. Thus, in Europe, hyperexcitability is considered a borderline (temporary) condition that does not require special adjustment, while in the countries of the post-Soviet space it is considered a pathology that requires treatment.
Be that as it may, hyperexcitability syndrome in newborns is a complex of symptoms provoked by neuro-reflex excitability and somato-vegetative disorders. And in a number of cases, in the absence of adequate treatment, disorders of nervous activity of varying degrees of severity occur, often making themselves felt in an older period of life.
Reasons for development
Hyperexcitability in newborns is associated with mild damage to the central nervous system during childbirth or even during pregnancy. Often, pathology occurs due to a lack of oxygen.
The main reasons for the development of pathology include:
- intrauterine infections;
- toxicosis, especially in later stages (preeclampsia);
- alcoholism, smoking during pregnancy;
- taking certain medications;
- fetal hypoxia, fetoplacental insufficiency;
- premature or post-term pregnancy;
- maternal stress during pregnancy;
- anatomical narrowing of the pelvis, which creates difficulties when passing through the birth canal;
- rapid or, conversely, prolonged labor;
- birth injuries.
In addition, symptoms of hyperexcitability in babies under one year of age are characteristic of the period of teething (at this time babies are especially restless) as well as with intestinal colic
Diseases such as rickets, spasmophilia, and neuro-arthritic diathesis leave their “imprint” on the nervous system. And, of course, temperamental children (cholerics) are easily excited.
Diagnostics
Of course, such diagnoses are made not by parents, but by a pediatrician together with a neurologist. If mom and dad noticed the manifestation of the above symptoms in the baby, he should be shown to specialists as soon as possible.
The problem of establishing the correct diagnosis during a physical examination is that often almost all young children behave restlessly in a new environment (the doctor's office), especially when they are undressed and touched by a stranger. Anxiety and crying in this case interfere with an adequate assessment of the baby’s condition.
The following diagnostic tests may also be necessary:
- neurosonography (ultrasound through an open fontanelle);
- electroencephalography;
- X-ray and ultrasound of the cervical spine;
- duplex scanning of cerebral vessels.
Using neurosonography, it is possible to determine whether there are organic lesions of tissues and cerebral vessels
Again, the examination should be carried out in a calm environment. The child must be well-fed and well-rested, otherwise crying during the study will distort the results.
Treatment
The choice of treatment will depend on the causes of hyperexcitability identified during diagnosis. Children under one year of age are often prescribed the following procedures:
Massage and exercise therapy. Helps relieve muscle tone. It is best to take massage courses under the guidance of a specialist who will tell you how many courses are needed and at what intervals to do them. He will also help you choose the necessary set of therapeutic exercises.
Swimming. The beneficial effects of water on the nervous system have long been known. The main thing is that during classes the child does not get scared due to accidentally swallowing water or getting it into his nose.
Physiotherapy. The physiotherapy complex includes amplipulse therapy, electrophoresis, and paraffin treatment. Such procedures normalize metabolism and improve cerebral circulation.
Taking salt and pine baths, as well as herbal teas with a sedative effect, also have a calming effect.
It is better to entrust massage to specially trained people.
Drug treatment. Children in the first year of life, if necessary, are prescribed medications with a sedative effect (for example, Glycine), nootropic drugs (improve brain and mental activity), such as Noofen, Pantogam, and sometimes diuretics, anticonvulsants.
Of course, children with increased excitability require a special regime. It is more important than ever for them to often walk in the fresh air, regularly ventilate the room, and try to develop a sleeping and eating routine. Breastfeeding allows you to give your baby the best nutrition and the skin-to-skin contact that your baby needs for emotional balance. It is recommended to pick up the baby more often and protect him from loud, frightening sounds as much as possible.
Sources
- https://NogoStop.ru/koleno/klonus-kolennoj-chashechki.html
- http://www.03.ru/terms/complaint/klonus
- https://ChtoiKak.ru/klonus.html
- http://NeuroDoc.ru/diagnostika/simptomy/klonusy.html
- http://mladeni.ru/zdorovye/gipervozbudimost-novorozhdennyh
Clonus can affect various parts of the body. Most often, rhythmic movements of the muscles of the foot, kneecap and hand are observed, less often – the toes and hands, forearm, lower jaw and buttocks. There are clonus that occurs spontaneously and that is caused by external stimuli.
Causes of spontaneous muscle contractions:
- epilepsy;
- diseases of the extrapyramidal system, accompanied by hyperkinesis - tic, tremor, hemiballismus, myoclonus, and so on;
- psychoneurological disorders.
Clonus caused by external stimuli is a consequence of increased excitability of the reflexogenic centers of the spinal cord. Its main cause is damage to the pyramidal tract of inflammatory, degenerative or vascular etiology. This clonus occurs in response to a single stretch of the tendon of the corresponding muscle. In this case, the mechanism of the inhibitory effect of the cerebral cortex on the motor neurons of the spinal cord is disrupted, as a result of which the contraction of antagonist muscles is repeated a large number of times.
The main diseases accompanied by disruption of the pyramidal system are meningitis, encephalitis, stroke, traumatic brain injury, brain tumors, and so on.
Foot clonus in infants may be one of the manifestations of muscle hypertonicity, which is a consequence of intracranial hypertension. Other causes of increased tendon reflexes are cerebral palsy, porencephaly, microgyria, gliomatosis, and so on. In addition, foot clonus in children, detected in the first days of life, may be a physiological phenomenon if there are no other pathological changes.
Symptoms
Clonus in epilepsy is observed during generalized convulsive seizures, which are accompanied by loss of consciousness. In this case, rhythmic contractions of the muscles of the trunk and limbs occur, which manifests itself in the form of rapid movements that are not controlled by the person.
The extrapyramidal system is responsible for involuntary coordination of movements, maintaining posture, muscle tone and motor manifestations of emotions. When it is damaged, muscle tone decreases, and various movement disorders occur, including clonus. It usually appears as tic twitching in the face, neck and limbs.
Clonus in neurosis is considered false. Its distinctive features are incorrect tempo, lack of rhythm and rapid exhaustion.
The function of the pyramidal system is to support complex and subtle coordination of movements. As a result of its damage, paresis, paralysis and pathological reflexes can occur. The latter include clonus of the feet and kneecaps.
Foot clonus is a sharp, rapid, involuntary jerking of the foot in response to a stretch of the Achilles tendon. It is called as follows. The patient lies on his back. The doctor bends his leg at the hip and knee joints, supporting it under the shin. With the other hand, the doctor grabs the foot, sharply bends it towards the front surface of the leg, and then straightens it.
Patellar clonus is the rhythmic movement of the kneecap along the bed, which occurs as a result of the tension of the tendon and the response contractions of the quadriceps femoris muscle. This is how it is provoked. Lying on his back, the patient straightens his legs. The doctor wraps two fingers around the kneecap, sharply pulls it down and holds it.
Normally, twitching of the feet and kneecaps should not occur. The situation is considered especially dangerous if there is an asymmetrical increase in reflexes.
Diagnostics
Pathologies of the pyramidal and extrapyramidal systems, in which clonus occurs, are identified on the basis of a neurological examination and clinical symptoms. In addition, the following diagnostic methods are used:
- MRI, CT, ultrasound of the brain;
- electromyography – assessment of electrical potentials of muscles;
- electroencephalography – registration of bioelectrical activity of the brain;
- blood and cerebrospinal fluid tests.
Treatment
Treatment tactics for identifying pathological reflexes are determined by the specifics of the underlying disease. As a rule, drugs are used that relax muscles, protect nerve fibers, and also affect brain function. In addition, patients with pyramidal and extrapyramidal disorders are indicated for physical therapy and psychotherapy.
Forecast
Diseases associated with damage to the pyramidal and extrapyramidal systems in most cases require constant maintenance therapy. Thanks to the integrated use of medications and physiotherapeutic procedures, a decrease in the rate of progression of pathological symptoms is achieved.
Prevention
The appearance of clonus can be prevented by preventing diseases of the pyramidal and extrapyramidal systems.
Videos demonstrating foot clonus testing
