What is myoclonic spasm? Myoclonic spasms Nocturnal jerks in adults.

After a busy day of work, the long-awaited time for relaxation finally comes. The person falls asleep, the body is relaxed, the brain is pleasantly foggy. But, suddenly - a sharp push, a feeling of falling, and a premature awakening. Why does a person twitch when falling asleep? Are tremors dangerous or are they annoying episodes that should be put up with - scientists, doctors and healers comment on the condition.

The scientific explanation for the startle when falling asleep

In ancient times, ancestors made completely mystical assumptions, explaining why a person twitches when he falls asleep. A parallel was drawn between falling asleep and the temporary departure of the soul to the kingdom of the dead. The involuntary twitching was perceived as a fearful reaction to the devilish touches.

The scientific approach to the study of startling during sleep includes different theories - from the first signs of incipient epilepsy to functional disorders of the hypothalamus (a part of the brain). Both hypotheses were found untenable.

Somnologists turned out to be more convincing. The study of the physiological phenomenon of individual theorists led to the conclusion that the cause of shuddering when falling asleep in both children and adults is a change in sleep phases. According to another theory, the hypothalamus uses reflex muscle movements to check whether the body is alive - after all, the brain perceives slow breathing, a decrease in pulse and heart rate during sleep as extinction.

Similarly, a cause-and-effect relationship has been identified between fatigue from daytime physical, psychological or mental overload and nighttime twitching. The reasons why a person twitches in his sleep are now systematized and grouped.

Physiological factors of night twitching

A sharp contraction of muscles when falling asleep and during sleep, similar in sensations to an electric shock, is called nocturnal myoclonus. Increased muscle tone generates positive myoclonus, decreased muscle tone generates negative myoclonus.

The simultaneous excitation of the nerve fibers going to the muscles leads to the fact that a person shudders in his sleep, he twitches, and a large tremor runs through the body. This phenomenon is classified in medicine as hypnagogic twitching.

The causes of physiological myoclonus fit into the following versions:

Neurophysiological. During the REM (rapid eye movement) sleep phase, the body and muscles are as relaxed as possible. A discrepancy is brewing between muscle tone and the “dying” body. To return to life from a state of sleep similar to death, the brain sends an impulse signal to the muscles. A strong shock, interrupting relaxation, causes a person to twitch when falling asleep.
Sleep phases. The alternating phases of paradoxical (shallow) and orthodox (deep) sleep affect brain activity. Dynamism is manifested in the signals sent to the brain, in response to which the human body begins to tremble.
Chronic stress. The cause of myoclonic spasms can be neurotic disorders or stress experienced during the day. The excited nervous system does not relax at night and re-experiences painful sensations before falling asleep.
Physical exercise. Overloaded muscles that are in good shape for a long time (sports, hard work, long walking) are not able to relax even during sleep. To gradually relieve tension, the brain sends an impulse to the muscles, which, by contracting, reduce tone - as a result, a person shudders or twitches in his sleep or at the moment of falling asleep.
Circulatory disorders. They are observed against the background of insufficient blood supply to the vessels, mainly of the lower and upper extremities. Oxygen-starved vessels collapse, limbs go numb, which prompts the brain to immediately send a signal order to change position. In a dream, a person tosses and turns, twitches, and even wakes up briefly. Changing posture leads to normalization of blood supply.
Myoclonus of fear. A sharp noise, a bright flash of light makes a sleeping person jerk sharply. The body's reaction is often accompanied by profuse sweating, rapid heartbeat, and tachycardia.
Myoclonus with apnea. A brief cessation of breathing during sleep causes the brain to wake up, followed by a start.

The listed symptoms, according to experts, are not a deviation, but a normal phenomenon. Jerking during sleep in children is also considered physiological (benign) myoclonus. Since the phases of sleep in children alternate and last differently than in adults, they twitch more often in their sleep or when falling asleep. The child's startling, even if it is constant but does not interfere with sleep, is also normal.

Pathological factors of myoclonus

Pathological myoclonus occurs for a number of reasons that determine whether it belongs to one type or another. Unlike physiological myoclonus, the pathological variety can be observed not only when falling asleep or during sleep, but also during the daytime.

The pathological background of the phenomenon of throwing up and jerking when falling asleep is often associated with brain lesions. Known as cortical myoclonus. Expressed in the following diseases:

Epilepsy . Oxygen starvation of the brain, degenerative movement disorders, and epileptic seizures lead to progressive muscle cramps. When falling asleep or in a dream, the whole body can shake, as well as individual parts - an arm, a leg, or there is an involuntary twitching of the head.
Essential myoclonus. A hereditary rare disease that develops from childhood. It is characterized by periodic arrhythmic and asymmetrical twitching of the limbs, sometimes of the maxillofacial muscles.
Hereditary degenerative lesions of the brainstem and cerebellum.
Viral inflammatory processes in the brain - tick-borne and other encephalitis.
Pathologies of the basal nucleus of the brain, affecting the motor function of the body.
Destruction of nerve fibers in pathologies of internal organs.
Neuroses and mental disorders.
Convulsions and tremors, more often affecting the lower extremities, are associated with a lack of calcium and magnesium in the body. A suitable vitamin and mineral complex prescribed by a doctor after laboratory tests will eliminate vibrations during sleep and when falling asleep.
Pathology known in medicine as Willis disease, Ekbom phenomenon or RLS (restless legs syndrome). It is expressed in the form of unpleasant twitching of the ankle when falling asleep and at night.

The factor that provokes cortical myoclonus is intoxication of the body, especially poisoning with salts of heavy metals. Injuries, taking or, conversely, abruptly stopping certain medications can also cause shuddering throughout the body and convulsions when falling asleep.

Both benign and pathological myoclonus are characteristic of representatives of both sexes. But boys and girls, that is, young people, suffer less often than the older generation.

Prophylaxis to prevent physiological myoclonus

Typically, nighttime twitching does not annoy a person and does not interfere with sleep. Minor discomfort experienced when falling asleep generally does not disturb the peace of night's rest. However, for people suffering from sleep disorders, twitching and sudden startlings do not allow them to fall asleep quickly and soundly. In this case, tips aimed at relaxing the body and calming the mind and brain will help:

refusal of traumatic television programs, reading action-packed literature, unpleasant conversations an hour before bedtime;
exclusion of late snacks and tonic drinks;
taking a warm shower;
before going to bed, detachment from daytime worries and painful thoughts;
herbal soothing teas;
balanced nutrition throughout the day, eliminating calcium and magnesium deficiency;
breathing relaxation before bed with yoga exercises;
A light relaxing massage is not forbidden;
if desired, taking aroma baths with calming essential oils (orange oil, lemon balm, lavender, lemon);
comfortable temperature and complete darkness in the bedroom;
Bedding made from natural fabrics and a comfortable bed are also important.

An aroma lamp in the bedroom with extracts of plants such as chamomile, lemon balm, rose, geranium, lavender will provide relaxation, regulate the pulse and quickly fall asleep. Symptoms of benign myoclonus do not require medical intervention, much less treatment. Simple measures aimed at normalizing sleep will reduce the negative sensations from nighttime twitching when falling asleep.

Doctor consultations and diagnostics

If all the efforts made do not bring the desired result, and twitching when falling asleep develops into a convulsion, it makes sense to visit a neurologist (neurologist). Diagnosis of myoclonus at the first stage is based on the patient’s description of the symptoms of night twitching and visual observation of muscle contractions (if they occur during the daytime).

Clarification of the diagnosis and identification of the causes of myoclonus is carried out using:

Electroencephalography (EEG) is a method that studies brain activity.
Additional biochemical blood tests for the content of sugar, urea, creatinine - reveal disturbances in the functioning of the pancreas, disruptions in metabolic processes, or indicate a decrease in kidney function.
Imaging processes - CT (computed tomography), MRI (magnetic resonance imaging) of the brain or radiography of the skull.

A neurologist prescribes and conducts the examination. In severe cases, hospitalization to a neurological clinic is indicated to make an accurate diagnosis of myoclonus.

Health care

Since the causes of physiological myoclonus are associated primarily with a person’s lifestyle, there is no need to treat it. The measures taken to normalize the process of falling asleep are usually enough for the phenomenon to go away on its own over time without consequences. In case of frequent manifestations of twitching when falling asleep and during sleep, the patient is prescribed sedatives - Novopassit (liquid or tablets), tincture of valerian, motherwort.

Excruciating cramps that cause pain and disrupt proper sleep require therapeutic intervention. As a rule, treatment is a multi-stage process. To get rid of myoclonus when falling asleep, prescribe:

Correction of the underlying disease leading to myoclonus. Usually this is a violation of biochemical processes in the body. Therefore, the first stage is to treat metabolic disorders. The syndrome is accompanied by pathologies such as arterial hypertension, diabetes mellitus, myocardial ischemia, even heart attack.
In the case of epileptic nature of twitching when falling asleep, anticonvulsants are prescribed.
General restorative therapy - taking sedatives and short courses of sleeping pills. This also includes all the principles of a healthy lifestyle.

Treatment of cortical myoclonus includes complex therapy. A course of potent drugs is prescribed:

Nootropics are brain stimulants.
Steroid drugs for the treatment of diseases of the musculoskeletal system - corticosteroids.
Neuroleptics are antipsychotic drugs.
Sedatives (reducing anxiety) are a class of benzodiszepines.

For positive dynamics of treatment of cortical myoclonus, it is important to correctly draw up a treatment regimen, which entirely depends on the qualifications of the doctor. In turn, the patient must tune in to a long and difficult recovery process, which requires endurance and patience.

Myoclonus syndrome does not pose a threat to human health. The benign variety can be eliminated by adjusting the daily routine and developing healthy habits. Pathological myoclonus is smoothed out in the process of systematic treatment and compliance with doctor’s instructions.

Myoclonic spasms are characterized by short-term muscle contractions of the body. This syndrome is accompanied by sudden shudders, convulsions, hiccups, etc. Convulsive spasms can occur both during sleep and during active physical activity of a person. Provocateurs of a sudden attack can be sharp sounds, bright light and even a sudden touch. In children, a similar reaction most often occurs when they are very frightened.

Reasons for the development of the disease

Currently, there are quite a lot of diseases that are accompanied by short-term seizures. If such symptoms occur, the reasons for its development should be found out.

The most common factors that contribute to the occurrence of myoclonic seizures are:

increased physical activity;
stress and emotional distress;
insufficient intake of vitamins and minerals into the body;
long-term use of caffeine-containing drugs;
nicotine addiction;
negative reaction to certain medications (estrogen, corticosteroids).

Quite often, cramps that are provoked by such reasons affect the fingers, eyelids and calves of the legs. As a rule, such a cramp is short-lived and stops on its own, without requiring serious treatment.

In addition, there are more serious factors that provoke myoclonus. These include:

dystrophic changes in muscle tissue;
the development of amyotrophic sclerosis, which is accompanied by the death of nerve cells;
spinal muscular atrophy;
muscle nerve injuries;
autoimmune diseases (Isaac syndrome), etc.

Despite the fact that myoclonic seizures, in most cases, do not pose a danger, any manifestations of this nature require consultation with a doctor and a thorough examination of the patient to exclude more serious symptoms.

Symptoms of an attack

A feature of myoclonic spasms is the absence of pain. Spasms can affect one or a group of muscles.

Visually, slight twitching of the face, hands, eyelids, etc. is observed. Their duration does not exceed 1 minute and most often such manifestations appear in a dream.

The following symptoms are observed with myoclonic spasms:

numbness and muscle tension in the head and neck area;
upper eyelid tic;
involuntary muscle contractions;
slight tremor of the limbs;
symptom of “restless legs” (swelling, cramps, etc.).

A myoclonic cramp in the calf area resembles a regular one, but there is a significant difference between them: with myoclonus there is no loss of consciousness, unlike a convulsive syndrome.

Course of an attack in childhood

In children, myoclonic spasms can be much more severe than in adult patients. Often myoclonus is accompanied by a generalized seizure, reminiscent of minor epilepsy with short-term loss of consciousness and convulsions.

Myoclonic epilepsy, in addition to seizures, can occur with absence seizures (symptoms of a type of short-term epilepsy), which are most often observed at the age of 4 years, but disappear as they grow older. These attacks are characterized by a short-term stupor of the patient, with his eyes open, but the person loses consciousness. Often, absence seizures in children can be a harbinger of juvenile myoclonic epilepsy.

In childhood, myoclonus is accompanied by tearfulness, emotional instability, and heightened impressionability, but with timely treatment this condition quickly stabilizes and the prognosis for recovery is favorable.

Classification of convulsive syndrome

Currently, there is the following classification of myoclonus:

Physiological. This type of myoclonic spasm is caused by physical fatigue, emotional and sensory outbursts. As a rule, physiological myoclonus is manifested by an attack of hiccups, night shudders and calf cramps.
Epileptic. The main factors in the development of epileptic myoclonus are diseases that can be accompanied by seizures. The symptoms of the disease manifest themselves quite clearly and gradually progress.
Essential. In this case, the cause of the myoclonic attack is a hereditary factor. The first symptoms of the disease appear at an early age, and their peak occurs during puberty.
Symptomatic. In this form, the main symptom of myoclonus is persistent ataxia of the soft palate. Based on localization, cortical, subcortical, peripheral and segmental foci are distinguished. The distribution of muscles is produced by segmental, focal and multifocal myoclonus with rhythmic and arrhythmic contractions.

Diagnostic methods

In order to prescribe adequate treatment, it is necessary to carry out diagnostic measures that will help exclude serious diseases, since in some cases myoclonus can be disguised as other, more severe manifestations. This condition especially affects children, as their symptoms are much more severe.

At the first visit to the doctor, a visual examination of the patient is performed and a detailed medical history is obtained, determining the possibility of genetic transmission, duration and frequency of myoclonic attacks, which makes it possible to differentiate seizures and their causes.

For a more accurate diagnosis, the following examination methods may be prescribed:

blood sampling for biochemical analysis;
X-ray examination of the head area;
electroencephalography.

Based on the data obtained and external examination, the neurologist makes a final diagnosis and prescribes all necessary therapeutic measures.

Treatment strategy

If myoclonic seizures are benign, if the attack occurs in response to natural stimuli (overexertion, fear, etc.), serious treatment is not required. For episodic manifestations, it is recommended to take sedative medications that normalize the nervous system. Sometimes taking tincture of valerian, motherwort or valocordin is quite enough.

For negative symptoms, which are aggravated by serious problems in the functioning of the brain and central nervous system, complex therapy with anticonvulsants is prescribed:

in order to block the transmission of nerve impulses, nootropics are prescribed (Piracetam, Cinnarizine, Phenotropil, Nootropil, etc.);
muscle relaxation and reduction of central nervous system activity can be achieved with the help of muscle relaxants and sedatives (Andaxin, Seduxen, etc.);
for severe and frequent seizures, as well as to prevent new seizures, injections of Oxybutyrate, Haloperidol and Droperidol are prescribed;
in severe cases, corticosteroids are prescribed, but only for a short course and under the supervision of the attending physician.

It must be remembered that preventing the development of convulsive syndrome, as well as eliminating the causes that provoke this condition, is of great importance. For example, if children experience frequent nighttime shudders, it is recommended to watch only calm TV shows before bed, as well as avoid active games that increase nervous excitability.

Correctly administered therapy and constant monitoring of the patient can reduce the frequency of myoclonic attacks several times. At the same time, a person leads a full life, without feeling discomfort when communicating with loved ones. In this case, the prognosis for recovery is favorable.

Most likely, there is not a single person on Earth who would not experience periodic startles when falling asleep.

Interestingly, scientists have not yet come to a consensus on why you startle when you fall asleep. There are 2 main versions of such tremors, and several more secondary ones. And I want to offer one version from myself, as a person who from time to time feels such awakening jerks when going to bed.

First of all, let's describe the flinch itself.

We are talking about a situation when you seem to have just fallen asleep when your body makes a jerk (shudder) of one force or another. Sometimes the shaking is so strong that the person literally hits the wall or bed with some part of the body.

Now, why do such shudders happen? As already mentioned, scientists have not reached a consensus on the origin of these shudders.

Unfortunately, this assumption does not seem competent enough, because Every person, when falling asleep, goes through the same sleep phases every time. In theory, then the shudders should happen every night, but they are quite rare.

Perhaps the implication is that startles occur only when a person moves too quickly from one stage of sleep to another.

The second assumption about startling when falling asleep is a reaction of a small part of the brain (the hypothalamus) to slow breathing and heart rate.

By forcing the muscles to contract sharply (at the same time the person feels the mentioned shudders), the hypothalamus thus checks the viability of the body. We are talking about a kind of testing of systems to make sure that the body is alive and functioning normally.

But if the hypothalamus tests internal systems in this way, then such a test would have to be carried out every time you fall asleep. However, as already mentioned, such flinches occur only from time to time, quite rarely.

Other causes of shuddering when falling asleep may include:

The result of stress and emotional experiences in a specific period of time;
Lack of magnesium in the body;
Reaction to external stimuli.

In other words, the question of the origin of the startle when falling asleep remains unexplored.

Another possible cause of shuddering when going to bed

Based on my own experience, I believe that the cause of such shudders is insufficient relaxation of the body muscles when falling asleep.

During sleep, especially during the phases of slow-wave sleep, the body is engaged in restoring the normal physical state of the body (more about this in the already mentioned article on the phases of sleep or on a similar topic).

If any of the body's muscles are not relaxed, they interfere with the physiological recovery process, and the body (through the hypothalamus or through other influences) tries to relax these muscles.

A jerk occurs, simultaneously waking the person up and causing tense muscles to relax. And then the process of falling asleep is repeated again.

Startling while falling asleep is a physiological phenomenon in which muscle contraction occurs and sometimes even a sudden cry may appear. When falling asleep, a person may make sudden movements of the limbs, which can be repeated every 10-15 seconds for a short period of time, or can be repeated during night sleep. During such a shock, a person may not feel anything, or he may wake up. Trembling is considered a normal phenomenon that can occur in any person from time to time, but it is most likely to occur during nervous fatigue. Tremors can be synchronous in different muscles or asynchronous; most often they are arrhythmic and accompanied by movement in the joint. In medicine, this phenomenon is called myoclonus. Tremors are classified according to the cause and location of muscle tension.

Depending on which muscle group is spasming, the source in the nervous system is determined. In this case, myoclonus is cortical, brainstem, spinal and peripheral.

Cortical myoclonus can be sudden and is most often triggered by movement or an external stimulus. It can be focal, multifocal or generalized. Cortical myoclonus often contributes to flexor muscle spasms.
Brainstem myoclonus occurs in the brainstem due to increased excitability of receptors. Reticular myoclonus is often characterized by generalized axial jerks, with proximal muscles being more involved than distal muscles. Reticular myoclonus can be spontaneous, actional or reflex.
Spinal myoclonus can occur with heart attacks, inflammatory and degenerative diseases, tumors, spinal cord injuries and other diseases. In most cases, it is focal or segmental, spontaneous, rhythmic, not sensitive to external stimuli and does not disappear during sleep.
Peripheral myoclonus occurs due to damage to the peripheral nerves and plexuses.

Most often, myoclanus is classified into: physiological, epileptic, symptomatic, psychogenic and essential.

Physiological myoclonus

Physiological tremors during sleep can occur under certain circumstances in a healthy person. In this case, the cause of shuddering may be severe fear, intense physical activity, hiccups and other phenomena. Most physiological causes can be eliminated. If you experience trembling caused by increased anxiety and worry, you should consult a psychotherapist. Myoclonus caused by fear can be not only physiological, but also pathological. Increased physical activity can cause sudden muscle contractions that do not require treatment. With hiccups, the respiratory muscles and diaphragm contract. This phenomenon may be the cause of overeating, or may be a symptom of a gastrointestinal tract disease. Hiccups may be caused by toxic influences or they may have a psychogenic cause.

Essential myoclonus

Essential myoclonus is a fairly rare hereditary disease. The disease begins at a young age, usually from 10 to 20 years, and is not accompanied by other mental and neurological disorders. Another form of essential myoclonus is nocturnal myoclonus, known as periodic limb movements. This disorder is not true myoclonus. The disease is characterized by repetitive movements in the legs in the form of extension and flexion in the hip, knee and ankle joints. Such periodic movements during sleep can be combined with restless legs syndrome.

Epileptic myoclonus

The cause of the twitching in this case is the disease epilepsy. Epileptic myoclonus can manifest itself in the form of single twitches, photosensitivity epilepsy, idiopathic “stimulus-sensitive” myoclonus, myoclonic absence seizures.

Symptomatic myoclonus

Symptomatic myoclonus develops as part of various neurological diseases:

Storage diseases, which are represented by a number of diseases in which a characteristic set of syndromes is revealed in the form of epileptic seizures, myoclonus and some neurological and other manifestations. Many of these diseases develop during infancy or childhood.
Hereditary degenerative diseases of the cerebellum, brain stem and spinal cord.
Viral encephalitis. Especially the disease caused by the herpes simplex virus and subacute sclerosing encephalitis...
Damage to nerve endings in diseases of the liver, pancreas, kidneys, lungs, in addition to disorders of consciousness.
Hereditary degenerative diseases with predominant damage to the basal ganglia.
Damage to nerve endings as a result of exposure to toxic substances. In this case, tremors during sleep may occur due to poisoning or an overdose of certain medications.
Encephalopathies caused by exposure to physical factors can also manifest as a typical myoclonic syndrome.
Focal lesions of the central nervous system.

Psychogenic myoclonus

Psychogenic myoclonus usually begins suddenly. In this case, shudders can be systematic, or they can occur with great frequency, resembling an isolated incident. Improvement is observed with distraction and psychotherapy.

Kalinov Yuri Dmitrievich

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In the evening after work we rush home. The day, as usual, was difficult: meeting and communicating with many people who were not always pleasant for us, running around accompanied by hassle, rush jobs, conflicts with management, etc. Home is our quiet haven, where you can relax, unwind, and throw off the burden of fatigue and daytime negativity. And so, after a delicious dinner, we sit in our favorite cozy chair or lie on a comfortable sofa. The TV flickers as usual, on the screen of which the heroes of the next series are saving the world, we fall into a slumber... And suddenly a sharp jolt, from which our legs tremble, forces us to wake up. Similar sensations occur from electric shocks. A familiar picture, isn't it? Where does this push come from, and why do your legs twitch when falling asleep?

Myoclonus: signs and characteristics of the syndrome

In medicine, the phenomenon of startling during sleep, in which involuntary sharp muscle twitches occur, is called nocturnal myoclonus. When the body reaches its greatest level of relaxation, active muscle contractions may occur, which is called positive myoclonus.

The appearance of a similar syndrome is also possible when muscle tone decreases. In this case, myoclonus is called negative. The described syndrome also has an alternative name - hypnagogic startle.

Myoclonus can affect local areas of the body, for example: only the right leg or even one of the leg muscles. In more complex cases, all limbs can twitch, sometimes even the facial muscles responsible for facial expressions. Based on the nature of myoclonic seizures, they are classified into rhythmic, arrhythmic, reflex, spontaneous, asynchronous, synchronous.

What is the essence of myoclonus? The brain is the control panel of the body. The movements of each part of the body are provided by certain muscle groups. To begin movement, muscle tissue must receive a corresponding signal from the brain, which arrives through the channels of the nervous system. The result of such signals is the excitation of muscle fibers with subsequent contraction of muscle tissue. If for some reason there is a simultaneous excitation of a whole group of channels of the nervous system, then a shuddering of the body or its individual parts begins. This phenomenon is called myoclonic spasms.

The hypothalamus is to blame for everything

In the intermediate part of the brain there is a section called the hypothalamus. This area is formed by a large number of cell blocks and is responsible for the normal functioning of many body systems. For example: it regulates metabolic processes, controls the endocrine, cardiovascular, and also controls the autonomic and many other systems. When a person falls asleep, the first phase of sleep begins, a decrease in body temperature and a drop in blood pressure occur. The breathing pattern changes: a significantly smaller volume of air is inhaled into the lungs and exhaled. This whole complex of changes in the body’s performance indicators is similar to the processes characteristic of death.

The hypothalamus regards this situation as dangerous, and in order to “resurrect” the body, return all its systems to an active state, it sends a discharge and creates a shake-up. Result: a sharp increase in muscle tone, expressed in body trembling.

Hypnagogic startle has no age, social or gender restrictions. This syndrome can manifest itself in one form or another in each of us. How can you determine whether you should worry and make an appointment with a neurologist if you notice myoclonic seizures or not? The determining moment is the duration of the startle in sleep. If this phenomenon is short-term, sometimes present in the initial phase of sleep, then there is no need to worry. This level of myoclonus is within the normal range and does not threaten health and proper sleep.

Everything is much more serious if myoclonic spasms accompany sleep throughout the night. This pathology does not allow you to get enough sleep, the body does not recover. Pathological myoclonus indicates significant health problems and can provoke the emergence of new diseases. In such circumstances, it is, of course, impossible to do without qualified medical care. The sooner treatment begins, the more effective its results will be.