Movements in the ICU

Name
Myoclonus

Description
Involuntary, shock-like
muscle jerking,
arrhythmic more often
than regular, of CNS
origin

Etiology
Multiple

Associations
Anoxic brain injury
Idiopathic epilepsy
Neoplasia
Encephalopathies
Degenerative Conditions (basal
ganglia, spinocerebellar)

Notes
Drugs useful in the
treatment of myoclonus
include clonazepam,
sodium valproate,
primidone, and piracetam.
These may need to be given
in combination to suppress
severe action myoclonus.

Fasciculations

Asynchronous muscle
twitches that typically
do not result in
movement at the joint
(twitching involves
entire motor unit)

-Spontaneous
activation of
muscle bundle,
insufficient to
move the joint
(site of
spontaneous
discharge from
motor nerve
uncertain)

Physiologically: after exercise

Myokymia

Involuntary,
spontaneous, wave-like
flickering of movement
within a muscle (cf.
fasciculations)

Multiple
(including
pontine lesions)

Neuromyotonia

-Neurogenic muscle
stiffness
-Spontaneous firing of
single motor units as
doublet, triplet, or
multiple discharges with
high-intraburst
frequency (40300/s) at
irregular intervals is the
hallmark finding.
Involuntary contractions
of muscle units which
results in hardening of
the muscle (often with
pain)

- Peripheral
nerve
hyperexcitability

CNS disease
Radiation injury
Associated w/ neuromyotonia
Toxicity
Autoimmune diseases (thyroid
disease)
20% of patients have
underlying small cell lung
cancer or thymoma
(paraneoplastic etiology)

-May be induced with light

percussion over a partially
denervated muscle belly
-Especially correlated with
compression of lower motor
neurons
-Facial and perioral
fasciculations are highly
characteristic of spinal and
bulbar muscular atrophy
-If involves single motor
fiber or group of fibers
smaller than a motor unit,
termed a fibrillation
-Often describe as having a
bag of worms appearance

Cramps

Local lactic
acidosis

Pathologically: Neurological
Conditions - Denervation of
muscles; Motor neuron disease;
neuropathy
Metabolic causes
thyrotoxicosis, tetany, after
AchE inhibitors, anaesthetic
muscle relaxants

-Dehydration w/ salt loss

-Pregnancy
-Metabolic sources:
hypothyroid; hemodialysis;
hypocalcemia; hyperventilation
-Neurological conditions:
Chronic peripheral neuropathy;
metabolic myopathies;
muscular dystrophies; motor
neuron disease; stiff man
syndrome

-Clinically this is manifest

as muscle cramps and
stiffness, particularly during
and after muscle
contraction, and as
muscular activity at rest
(myokymia, fasciculations).
-Improves w/ symptomatic
tx such as carbamazepine
-Must distinguish from
myotonia, which is stiffness
in muscles after voluntary
contraction / induction of
contraction
-Treatment involves
addressing underlying
abnormality
-The term stiffness is
usually reserved for
disorders in which stiffness
is the principal symptom
due to continuous motor
unit activity within muscles.