Clonus After Stroke: How to Get a Handle on Uncontrollable Shaking

Clonus after stroke results in uncontrollable, rhythmic shaking similar to tremors. However, clonus is its own condition and needs to be treated as such.

To help you understand clonus after stroke, you’re about to learn the causes, symptoms, and treatment. Let’s get started.

Cause of Clonus After Stroke

Clonus is a neurological condition that results in unintentional, pulsing muscular contractions.

Specifically after stroke, clonus may occur if the stroke damaged the motor neurons in the brain. These neurons are responsible for getting information from your brain to your muscles.

Clonus after stroke most commonly occurs in the ankles and knees, but it can occur in other areas as well.

Clonus is often confused with tremors after stroke because both involve unintentional shaking or rhythmic movements. However, clonus can be triggered by stretching the affected muscles while tremors are not.

Clonus may occur alongside spasticity, which is a common secondary effect of stroke that involves tight, stiff muscles that are in a state of over-contraction. But again, the conditions are different.

Spasticity results in a velocity-dependent tightness of a muscle, which means the faster the muscle is stretched, the tighter it gets. Contrastingly, clonus results in an involuntary, pulsing contraction of the muscles, but can also be triggered by a stretch reflex similar to spasticity.

The slight differences between clonus and other neurological conditions like tremors after stroke make it extra important to work with your doctor for proper diagnosis.

Symptoms of Clonus After Stroke

People with clonus after stroke may experience these symptoms:

• Rhythmic shaking stimulated through stretch reflex
• Spasticity as a co-occurring condition
• Fixed joints as a co-occurring condition (also known as contractures)
• Increased muscle tone
• Involuntary leg-crossing
• Muscle fatigue due to muscle pulses for extended periods of time
• Trouble sleeping due to constant motion of the limbs
• Excessive daytime sleepiness as a result of disturbed sleep

If you struggle with any of these symptoms, talk to your doctor. They can help diagnose your condition and provide treatment, which may include some or all of the following:

Treatment for Clonus After Stroke

Here are the most common treatment options for clonus after stroke:

1. Rehabilitation Exercise

Rehabilitation exercise focuses on practicing specific movements to help rewire the brain through neuroplasticity.

When the motor cortex has been damaged by stroke, neuroplasticity allows healthy parts of the brain to “pick up the slack.” As the brain relearns how to communicate with your muscles, clonus may subside.

Repetition is key (i.e. “massed practice”). Each time you practice an exercise, you fire specific neurons in the brain. The more these neurons fire together, the stronger their connection becomes.

Rehab exercise is a safe, non-invasive treatment for clonus after stroke. Talk to your therapist to get some rehabilitation exercises you can safely practice at home.

2. Medications

It takes time to rewire the brain through rehab exercise. Another treatment option to consider in the meantime is medication for clonus after stroke.

Medications such as muscle relaxants (like baclofen and tizanidine) and sedatives (like clonazepam and diazepam) can help temporarily reduce clonus symptoms and spasticity to provide relief.

Talk to your doctor to see if medication is a good option for you.

3. Botox

Botox injections can help relax muscles by serving as a temporary nerve-block to relieve the symptoms of clonus after stroke.

While the clonus is temporarily relieved, it gives patients an opportunity to practice physical therapy exercises to rewire the brain and improve clonus long-term.

4. Compensation techniques

Compensation techniques can help you manage the symptoms of clonus to improve quality of life, although they won’t be addressing the root cause of the problem. Here are some tips to cope with clonus after stroke:

• Use cold packs to soothe achy muscles
• Apply heat packs for pain relief
• Try magnesium supplements or magnesium salt baths to help relax muscles

As always, be sure to talk to your doctor before trying magnesium or other supplements as this can interact with other medication.

5. Surgery

If clonus is affecting your quality of life and none of the above treatments help, then your doctor may recommend surgery. This is a last resort.

Coping with Clonus After Stroke

Clonus results from damage to the motor neurons in the brain, and there is hope for recovery because the brain is capable of rewiring itself.

Work with your medical team to come up with a treatment plan. Methods that encourage the brain to rewire itself, like rehab exercise, should be favored due to their noninvasive nature.

With the help of your medical team and hard work, your clonus may subside. Good luck!