It is not our intention here to seek to provide a differential diagnosis
between tic and the various conditions usually classed as myoclonus, and
that for two reasons: in the first place, we cannot admit that the
latter form a distinct clinical or nosographical entity, since the term
myoclonus seems simply to be an abbreviation for clonic muscular
convulsion, and is a symptom rather than a clinical syndrome; secondly,
the fact that the tics themselves have been incorporated with myoclonus
involves the investigation of all the published cases with a view to
their critical sifting. This task we have pursued for our own
edification, but to enter on it here would serve no useful purpose, and
we shall rest content with examining succinctly several recent cases
described as myoclonus, in the hope that the prosecution of further
research will introduce order into what is at present chaos.
* * * * *
Among the various forms of myoclonus there is one which presents a
certain individuality, and which was described originally by Friedreich
under the name of paramyoclonus multiplex.
This disturbance of motility supervenes, in patients with a neuropathic
heredity, after some psychical accident such as a sudden fright or
emotion, and consists in clonic muscular convulsions affecting the body
generally, with the exception of the face. The contractions appear
without obvious cause in one or in several muscles, are instantaneous,
involuntary, and usually bilateral, but their most important feature is
their inequality and irregularity. They may or may not effect
displacement of the limbs; in any case they compose neither gesture nor
gesticulation. Volition occasionally seems to have some transient
inhibitory influence over them; they are exaggerated by cold and by
emotion, and usually disappear in sleep.
It is obvious that this account of a typical case precludes the
possibility of any confusion with tic, but the published cases are not
always in conformity with it.
In 1892 Lemoine[181] reported a case where the movements of
paramyoclonus multiplex were accompanied with echolalia and psychical
changes. Raymond quotes an instance of the disease being preceded by
facial tic, and another associated with tremor and choreic movements.
D'Allocco[182] has recorded twenty-four cases of differing forms of
myoclonus, of which nineteen occurred as a family disease, in
conjunction with stigmata of degeneration, epilepsy, and hysteria.
In a patient, aged twenty-six, suffering from general paralysis,
Hermann[183] noted the presence of abrupt, irregular, myoclonic twitches
in the sternomastoids, recti abdominis, adductors, and in some of the
toes and fingers, first on one side and then on the other, also in both
legs, and subsequently in both arms, the face being unaffected.
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