Clonus is commonly seen in the ankle but may exist in other distal structures as well, such as the knee or spine. Diagnosis
The clinical underpinnings of two of the most common spasticity conditions, spastic cerebral palsy and multiple sclerosis, can be described as follows: in spastic diplegia, the upper motor neuron lesion arises often as a result of neonatal asphyxia, while in conditions like multiple sclerosis, spasticity is thought by some to be as a result of the autoimmune destruction of the myelin sheaths around nerve endings—which in turn can mimic the gamma amino butyric acid deficiencies present in the damaged nerves of spastic cerebral palsy children, leading to roughly the same presentation of spasticity, but which clinically is fundamentally different from the latter.Spasticity is assessed by feeling the resistance of the muscle to passive lengthening in its most relaxed state. A spastic muscle will have immediately noticeable, often quite forceful, increased resistance to passive stretch when moved with speed and/or while attempting to be stretched out, as compared to the non-spastic muscles in the same persons body (if any exist). As there are many features of the upper motor neuron syndrome, there are likely to be multiple other changes in affected musculature and surrounding bones, such as progressive malalignments of bone structure around the spastic muscles (leading for example to the scissor gait and tip-toeing gait due to ankle equinus or ankle planter flexion deformity in spastic cerebral palsy children.
Treatment
Parasomnias can be considered as potentially harmful to oneself as well as to bed partners, and are associated with other disorders. Children with parasomnias do not undergo medical intervention, because they tend to recover the NREM-related disorder with the process of growth. In those cases, the parents receive education on sleep hygiene to reduce and eventually eliminate precipitating factors.In adults psychoeducation about a proper sleep hygiene can reduce the risk to develop parasomnia. Case studies have shown that pharmacological interventions can improve symptoms of parasomnia, however mostly they are accompanied by side-effects. Behavioral treatments, i.e., relaxation therapy, biofeedback, hypnosis, and stress reduction, may also be helpful, but are not considered as universally effective. Prognosis
NREM-related parasomnias which are common in childhood show a good prognosis, since severity decreases with age, the symptoms tend to resolve during puberty. Adults with NREM-related parasomnias, however, are faced with a stronger persistence of the symptoms, therefore, full remission is quite unlikely and is also associated with violent complications, including homicide. The variant sleep-related eating disorders is chronic, without remission, but treatable.REM sleep behavior disorder (RBD) can mostly be handled well with the use of melatonin or clonazepam. However, there is high comorbidity with neurodegenerative disorders, that is in up to 93% of cases. The underlying psychopathology of nightmare disorder complicates a clear prognosis.The prognosis for other parasomnias seems promising. While exploding head syndrome usually resolves spontaneously, the symptoms for sleep-related hallucinations tend to diminish over time. See also
Dyssomnia
Insomnia
Rhythmic movement disorder
Sleep medicine
Sleep paralysis
Alien abduction, which some investigators claim is caused by parasomnia.