Suggest Treatment For Severe Weakness In The Leg When Diagnosed With Parkinson's Disease

Posted on Fri, 15 Jul 2016

Question: My legs became weak over a period of a few days, they collapsed on me. i have Parkinsons disease.When can I get an answer? Meds are carb/lev/entac 175,,4 x day, requip 3mg 4 x day, amantadine 100mg 2 x day.

Answered by Dr. Ishu Bishnoi (1 hour later)

Brief Answer:
Needs details of your complaint and few differential diagnosis

Detailed Answer:
Hi xxx658, thanks for asking from HCM.

I can understand your concern. The acute weakness of legs could be due to many reasons like

: Peripheral neuropathy due to Requip

: Bradykinesia - Extreme slowness of movements may present as weakness. It is a common manifestation of uncontrolled Parkinson disease.

: Hypokinesia - Same as Bradykinesia. It is a side effect of Amantadine.

: Paralysis - It is a reported side effect of Requip.

Before reaching unto some conclusion, I need to know few details

: For how many years, you are taking these medication, especially Amantadine/Requip?

: Any history of Diabetes Mellitus, Alcohol.

: How much weakness is there? Like are you able to move, feel pain/touch ?

: Is there any back pain? What is the level in legs like thigh, legs, feet?

Hope you will understand my point. You can consult your doctor regarding possibility of drug side effects and evaluation of weakness.

If there is any doubt, do let me know. After getting answers of my questions, I will help you in reaching some conclusion.

Thanks. Take care.

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Ishu Bishnoi (2 hours later)

I have been on Requip for years (10 to 12). I've tried Amantadine on three occasions but quit the first two times, it was making me urinate too much. I've been on it or two months this time. weakness in legs seems to be in theighs. when I fall, it takes getting next to a table or chair to get up on my feet. Prior to that I have had no problem getting up.

I had DBS seven years ago. that changed my life. it has to be the meds. I forgot I tried time released Requip for about two weeks a couple weeks ago. DIdn't seem to help so I went back to the regular dose of 3mg 4 x a day.

Thanks, XXXXXXX Herron

Answered by Dr. Ishu Bishnoi (9 hours later)

Brief Answer:
Proximal weakness cause and approach

Detailed Answer:
Hi Txxx658, welcome back.

Thanks for answering my questions. I have read the details of your complaint. It seems that you are having proximal muscular weakness (thigh involvement). It can be
: Proximal myopathy
or
: Peripheral proximal neuropathy

Now first we need to confirm our diagnosis and then find the cause and treat it.
To know the diagnosis, you should consult neurologist. He will examine your
: Neuromuscular system
After confirming weakness and any sensory loss, he will advise investigation to confirm it

: Creatine kinase (CK) levels with isoenzymes
: levels of electrolytes, calcium, magnesium, sugar
: Serum myoglobin levels
: Serum creatinine and blood urea nitrogen levels
: Urinalysis: Myoglobinuria indicated by positive urinalysis with few red blood cells on microscopic evaluation
: Complete blood count
: Thyroid function tests
: Aspartate aminotransferase levels
: Electrocardiography
: Electromyography and Nerve conduction velocity
: Magnetic resonance imaging (to assess complications or rule out neurologic disease) of lumbar spine and nerves
: Muscle biopsy

These tests will be needed only if cause of weakness is not drug related (Requip and amantadine use). It can only be suspected after ruling out other causes. Confirmation is after stopping the drug, patients symptoms improve. So there is need of above mentioned investigations to rule out other causes.

Treatment will depend upon diagnosis. Usually management is medical.

Hope it will help you. Thanks. Take care

Above answer was peer-reviewed by : Dr. Yogesh D