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My baby is 5 weeks old and seems to be progressing normally.

I happened to notice the...
My baby is 5 weeks old and seems to be progressing normally. I happened to notice the other day, by chance, that his leg shook when I put pressure on his foot. I read about ankle clonus, and at first, there were only 3-5 beats, but when I checked just now, there were about 10-12 beats. It only happened one time so far. It is seen bilaterally. He does not have any stiffness. I am so worried that he might have CP as I have read that any more than 10 beats is always abnormal.
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Answered in 18 minutes by:
11/21/2017
Dr Subbanna MD
Dr Subbanna MD, Neurologist (MD)
Category: Neurology
Satisfied Customers: 5,705
Experience: American Board Certified Neurologist, Internal Medicine
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Hi, I am an American Board Certified Neurologist with vast experience in diagnosing & treating all neurological as well as all other health/medical conditions including pediatric neurology, and I am very glad to help you with your health concerns related to your baby.

I see you are concerned about the ankle clonus in your baby as you have described above. As a neurologist I very frequently check clonus testing in my adult as well as pediatric patients, I am very familiar with this test & its interpretation and I can certainly help you in this regard.

I am currently preparing & typing my answer and I will post my answer here as soon as it is ready.

Best Regards!

Dr Subbanna MD

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I am almost done with my typing; I will follow up with you very soon.

Best Regards!

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Once again I can fully understand your concern, but please see just an isolated clonus finding cannot be considered as abnormal

First of all ankle clonus is normally seen in young babies. This test commonly comes positive until the first several months after the birth

Now regarding how many beats are considered as normal, please see on an average the beats are up to about 10, but if the clonus beats are bit more than 10 we cannot automatically consider it as abnormal

Not all normal people have their lab values or test findings perfectly within the normal range, the normal range what we generally consider is applicable to about 95 to 98% of the normal population and as you see there are several normal individuals who can have their test values outside the normal range

So having just few beats above the normal range does not indicate this is abnormal

I see your baby is progressing normally, and he is not having any other obvious neurological clinical findings such as stiffness, so all these indicate this must be a normal finding for him

If you have still doubts then please try to get him examined by a neurologist in the clinic, but it really does not appear he is a case of CP, or any other neurological issues

Once again I reassure you, having few beats of ankle clonus above the normal range is certainly not to be considered abnormal for the various reasons discussed above, it appears your son is growing and developing normally, if you are still concerned please try to get him examined by a neurologist in the clinic, but it certainly does not appear he is having any neurological issues including CP etc, so please not to be scared.

Please let me know if you have any additional questions or if you want to discuss this further.

Assuring you the best services!

Best Regards!

Dr Subbanna MD

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Customer reply replied 26 days ago
Thank you so much for your response. That makes me feel much better. I just want to clarify; ankle clonus, by itself, is not considered abnormal unless other abnormalities are found with it? He does not seem to have any other abnormalities and all of his reflexes are normal and as I mentioned no stiffness. He does however have benign neonatal sleep myoclonus. Could this have anything to do with the ankle clonus? Also, could the ankle clonus be related to an immature nervous system? Thank you so much for your time Dr.

You are very welcome! I am typing now, I will follow up with you very soon.

Best Regards!

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Yes, isolated ankle clonus cannot be considered as abnormal. There has to be other neurological findings too, otherwise ankle clonus in a young baby as him has no clinical significance

And benign neonatal sleep myoclonus is considered as normal. It itself may not be causing these myoclonus, but this type of clonus is considered normal for his age.

Once again, as pointed above, ankle clonus is considered as normal for young babies as him, and in the absence of any other abnormal neurological findings, such as abnormal reflexes, stiffness, or any other abnormal findings this isolated ankle clonus, even if beats are above 10 it is still not to be given any significance.

Please let me know if you have any additional questions or if you want to discuss this further. And please take a moment and kindly click a positive rating (preferably 5 Star/Excellent) to credit for the time & effort put by me in answering your health question, and this is the only way I will be credited for my service to you. If you have follow-up or additional questions you can ask them after the rating too!

Assuring you the best services!

Best Regards!

Dr Subbanna MD

Dr Subbanna MD
Dr Subbanna MD, Neurologist (MD)
Category: Neurology
Satisfied Customers: 5,705
Experience: American Board Certified Neurologist, Internal Medicine
Verified
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Customer reply replied 26 days ago
I absolutely rated you with 5 stars. Thank you very much for your time. It is startling to see his foot twitch like that along with the sleep myoclonis twitching, I felt that something must be wrong. One more question. Should I have him evaluated for the sleep myoclonus? He’s never been seen for it but I have seen videos of it and he only does the twitching during NREM sleep and stops immediately upon awakening. Also, have you seen many normal babies with ankle clonus > 10? Thank you again Dr.

You are very welcome! I am very glad to hear you found the above information helpful!

I appreciate the 5 star excellent rating!

The sleep myoclonus that you have described above appears normal, and benign in nature, however if it persists then please try to get this evaluated in a neurology clinic.

To your other question, yes as a neurologist I see many babies who have possible neurological concerns, and I have certainly seen some babies who were perfectly normal but still had clonus beats above 10. So having clonus beats above 10 itself is not considered as abnormal in babies of his age, and in his case it certainly does not appear abnormal for the reasons discussed earlier above (he is progressing normally, no other neuro findings etc).

Wishing you all the very best!

Thanks & Best Regards!

Dr Subbanna MD

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Customer reply replied 26 days ago
Thank you very much for the peace of mind!

You are very welcome! My pleasure!

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Customer reply replied 26 days ago
I’m so sorry, one last question. You stated if the sleep myoclonus persists to have it evaluated. Do you mean if it persists beyond a certain age or do you mean if it happens again? He does it roughly 2-3 times a week.

It is fine, no problems, please clarify if you have any doubts.

I am sorry, I did not explain it properly. Please see benign neonatal myoclonus may persist up to about a year or so (during the infancy, or upto about age 1), so if it persists above this period then it may require an evaluation.

Considering that he is not even getting this regularly (means not on daily basis) this clearly indicates this is entirely benign and this is going to resolve in the near future, so please not to be scared.

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Customer reply replied 26 days ago
Thank you so much Dr. I truly appreciate your responses!

You are very welcome! I am very glad to be of help!

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Dr Subbanna MD
Dr Subbanna MD, Neurologist (MD)
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