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What Causes Myoclonic Jerks And Body Shaking In An Infant?
Question: Hello Doctor, My son 9 month old , shakes body while excited, or if want something etc. Day before yesterday we saw a myclonic jerk while he was sitting on bed and watching washing machine rolling. Some time he shakes head as if he is saying no. We went to Pedatric neurologist yesterday, she saw the video of the jerk and other activity. She did confirm the jerk looks like myoclonic jerks. She ordered EEG and Bold test for calcium and Glocous. EEG and blood test report looks normal. But she advised to provide Levipil Syrp 0.8 Ml twice a day for three month. I am not very sure if he has myoclonic jerk problem, Worried about the side effects of the medicine for 9 month old. Please advise
Brief Answer:
may require medicine, less side effects
Detailed Answer:
Hello XXXX
I have gone through your question and understand your concerns.
There are few queries regarding your son problem.
Is there any other type of seizure like loss of tone, tonic posturing, fever, regression in milestones.
If only myoclonic jerks are there with precipitation on excitement or startle (sudden sounds like washing machine) then following may be etiologies
1) Fejerman syndrome - common in boys, starts in first year of life, benign, good prognosis, remissions at 2-3 years of age. No treatment required usually.
2) myoclonic epilepsy in infancy - only myoclonic jerks, common in boys, starts in first year of life, head nodding present, eeg may be abnormal, other seizure type may be present. Treatment required with good prognosis. Remission before 5 years of age. Valproate, clonazepam or levetiracetam can be given.
3) Dravet syndrome - usually associated with other seizure types, less likely in your case at present.
As you have consulted a pediatric neurologist and she has viewed the video then treatment according to her will be sensible option.
Sometimes it's difficult to differentiate between pathological or physiological etiologies at early stage of disease. It's better to give treatment and be in regular follow up. Consult immediately if you notice something new.
Regarding side effects, levetiracetam is a new drug with minimal side effects and is safe. Valproate can be other option.
Hope you found the answer helpful.
Do get back to me for further queries.
Regards
Dr Neeraj Kumar
Neurologist
may require medicine, less side effects
Detailed Answer:
Hello XXXX
I have gone through your question and understand your concerns.
There are few queries regarding your son problem.
Is there any other type of seizure like loss of tone, tonic posturing, fever, regression in milestones.
If only myoclonic jerks are there with precipitation on excitement or startle (sudden sounds like washing machine) then following may be etiologies
1) Fejerman syndrome - common in boys, starts in first year of life, benign, good prognosis, remissions at 2-3 years of age. No treatment required usually.
2) myoclonic epilepsy in infancy - only myoclonic jerks, common in boys, starts in first year of life, head nodding present, eeg may be abnormal, other seizure type may be present. Treatment required with good prognosis. Remission before 5 years of age. Valproate, clonazepam or levetiracetam can be given.
3) Dravet syndrome - usually associated with other seizure types, less likely in your case at present.
As you have consulted a pediatric neurologist and she has viewed the video then treatment according to her will be sensible option.
Sometimes it's difficult to differentiate between pathological or physiological etiologies at early stage of disease. It's better to give treatment and be in regular follow up. Consult immediately if you notice something new.
Regarding side effects, levetiracetam is a new drug with minimal side effects and is safe. Valproate can be other option.
Hope you found the answer helpful.
Do get back to me for further queries.
Regards
Dr Neeraj Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Yogesh D
Hello Sir,
Thank you for the answer.
Do you mean to say loss of tone means, loss of muscle tone? we didnt notice any such thing till today, however he generally makes loud sound while laughing or crying, but some time I did notice he sounds in pale tone. We thought pale tone may be due to the fact he was making noise in high pitch. But after pale tone he do babbles in high pitch, I am not sure if I understood your question correctly/provided the answer to your question.
But we didn't notice any fever. His growth details are as listed below:
At birth : Weight 3.00Kg
At 6 month: Weight 7.05, Length 63 cm, HC 42cm
At 9 month Weight 7.58, Length 66/67 cm , HC 43.4 cm (Refuse to eat solid foods may be due that he didnt gain much weight as well as activity increased after 6 month)
His other activities looks normal, now he is able to crawl easily, able to sit independently , try to stand by holding something, if I hold hand he is able to move the leg forward and put couple of steps, Babbles, able to hold big toys, XXXXXXX bell, pick plates, XXXXXXX try to pick small dust or piece by using finger.
Other thing I noticed is he sweats bit more in head.
Doctor has suspect benign myoclonic epilepsy of infancy.
We started providing medicine from yesterday, as instructed by doctor.
Do you think low tone is another type of seizure?
I understand EEG could be normal in this type of epilepsy, but please let me know your thoughts.
Is this curable completely? No one in family has this kind of disorder.
Let me know if you need any further details.
Thank you. XXXXXXX
Thank you for the answer.
Do you mean to say loss of tone means, loss of muscle tone? we didnt notice any such thing till today, however he generally makes loud sound while laughing or crying, but some time I did notice he sounds in pale tone. We thought pale tone may be due to the fact he was making noise in high pitch. But after pale tone he do babbles in high pitch, I am not sure if I understood your question correctly/provided the answer to your question.
But we didn't notice any fever. His growth details are as listed below:
At birth : Weight 3.00Kg
At 6 month: Weight 7.05, Length 63 cm, HC 42cm
At 9 month Weight 7.58, Length 66/67 cm , HC 43.4 cm (Refuse to eat solid foods may be due that he didnt gain much weight as well as activity increased after 6 month)
His other activities looks normal, now he is able to crawl easily, able to sit independently , try to stand by holding something, if I hold hand he is able to move the leg forward and put couple of steps, Babbles, able to hold big toys, XXXXXXX bell, pick plates, XXXXXXX try to pick small dust or piece by using finger.
Other thing I noticed is he sweats bit more in head.
Doctor has suspect benign myoclonic epilepsy of infancy.
We started providing medicine from yesterday, as instructed by doctor.
Do you think low tone is another type of seizure?
I understand EEG could be normal in this type of epilepsy, but please let me know your thoughts.
Is this curable completely? No one in family has this kind of disorder.
Let me know if you need any further details.
Thank you. XXXXXXX
Brief Answer:
Good improvement will occur
Detailed Answer:
Hello XXXX,
Loss of tone means muscle tone.
Such a presentation leads to sudden loss of standing or sitting posture without loss of consciousness.
Other type seizure may point to some other epilepsy syndrome.
Only myoclonic jerks are present at this age in diseases discussed earlier.
There are good chances that the boy will have good response to treatment and remission occurs.
God bless your son.
Get back to me for further queries.
Regards
Dr Neeraj Kumar
Neurologist
Good improvement will occur
Detailed Answer:
Hello XXXX,
Loss of tone means muscle tone.
Such a presentation leads to sudden loss of standing or sitting posture without loss of consciousness.
Other type seizure may point to some other epilepsy syndrome.
Only myoclonic jerks are present at this age in diseases discussed earlier.
There are good chances that the boy will have good response to treatment and remission occurs.
God bless your son.
Get back to me for further queries.
Regards
Dr Neeraj Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
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