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Suggest Treatment For Weakness On The Legs
Question: Symptoms
My name is XXXX, aged 50, and suffering from lumber disc problem for the last four-odd years. My symptoms are weakness in the legs often causing me to drag my left feet. I have difficulty in rising from squatting position as also rising from a seated position. My feet movement are also slow and a diagnose by doctors at Shri XXXXXXX Tirunal Hospital, XXXXXXX suggested that I have early Parkinson’s Disease. An EMG/NCS report taken in February 2013 concluded “mild pure sensory axonal poly neuropathy including both lower limbs symmetrically”, “Left SI radiculopathy”, inelicitable SNAP from left femoral cutaneous nerve could be due to technical reasons or partial lumbar plexopathy”.
MRI of lumbar spine taken in XXXXXXX 2012 shos mild ostereoporotic changes noted to lumbar spine in the form of fatty replacement. L3-L4 disc annular bulge with broadbased left forminal/extraforminal herniation indenting the thecal sac, L4-L5 disc annular bulge indenting the thecal sac and bilateral L4 traversing the nerve roots, L5-S1 disc anular bulge with annular tear and bilateral S1 traversing nerve roots. Was prescribed Pramipex for Pakinson’s but no medication for the lumbar disc.
What exactly is my problem?
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My name is XXXX, aged 50, and suffering from lumber disc problem for the last four-odd years. My symptoms are weakness in the legs often causing me to drag my left feet. I have difficulty in rising from squatting position as also rising from a seated position. My feet movement are also slow and a diagnose by doctors at Shri XXXXXXX Tirunal Hospital, XXXXXXX suggested that I have early Parkinson’s Disease. An EMG/NCS report taken in February 2013 concluded “mild pure sensory axonal poly neuropathy including both lower limbs symmetrically”, “Left SI radiculopathy”, inelicitable SNAP from left femoral cutaneous nerve could be due to technical reasons or partial lumbar plexopathy”.
MRI of lumbar spine taken in XXXXXXX 2012 shos mild ostereoporotic changes noted to lumbar spine in the form of fatty replacement. L3-L4 disc annular bulge with broadbased left forminal/extraforminal herniation indenting the thecal sac, L4-L5 disc annular bulge indenting the thecal sac and bilateral L4 traversing the nerve roots, L5-S1 disc anular bulge with annular tear and bilateral S1 traversing nerve roots. Was prescribed Pramipex for Pakinson’s but no medication for the lumbar disc.
What exactly is my problem?
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Brief Answer:
My sincere suggestion is to seek a revised opinion from a neurosurgeon.
Detailed Answer:
Hi,
Sorry that you have been experiencing all these symptoms. At the outset I want to confirm if you are having any complaints like continuous shaking of arms (tremors), stiffness in the arms (rigidity) or continuous subtle movements in your fingers. Because these are all the hallmarks of Parkinsonism. Yes the slow gait too is a part and parcel of PD (Parkinson's disease) but however I think it is more due to the neuropathy that you seem to have alongside. There is no real objective diagnostic test for PD and hence it should always be made with a good acumen. I think you should seek a second opinion from another neurologist for PD.
As for the foot drop symptoms (dragging of feet) and muscle weakness in getting up from sitting position, I think they are mainly due to the nerve compression happening at L4-5, L5-S1 levels and the S1 radiculopathy. That needs your immediate attention as there is pronounced motor weakness. I think since the last MRI is more than 2 years old, a new one is warranted, and with this MRI you should see a good neurosurgeon immediately. You will probably need a decompression surgery as soon as possible. It is not a very major one in terms of morbidity. Though depending on the MRI the surgery may get revised. Meanwhile please take a few prescription medications like Pregabalin-M twice a day. This may make you a bit drowsy for the first few days, but you will slowly find yourself without the drowsiness after those days. I think a nerve biopsy too is warranted but can be done later if the neuropathy doesn't improve. But please take good care and see another neurosurgeon, the sooner the better.
If you have any more doubts or clarifications, you are always welcome.
Regards,
Pradeep
My sincere suggestion is to seek a revised opinion from a neurosurgeon.
Detailed Answer:
Hi,
Sorry that you have been experiencing all these symptoms. At the outset I want to confirm if you are having any complaints like continuous shaking of arms (tremors), stiffness in the arms (rigidity) or continuous subtle movements in your fingers. Because these are all the hallmarks of Parkinsonism. Yes the slow gait too is a part and parcel of PD (Parkinson's disease) but however I think it is more due to the neuropathy that you seem to have alongside. There is no real objective diagnostic test for PD and hence it should always be made with a good acumen. I think you should seek a second opinion from another neurologist for PD.
As for the foot drop symptoms (dragging of feet) and muscle weakness in getting up from sitting position, I think they are mainly due to the nerve compression happening at L4-5, L5-S1 levels and the S1 radiculopathy. That needs your immediate attention as there is pronounced motor weakness. I think since the last MRI is more than 2 years old, a new one is warranted, and with this MRI you should see a good neurosurgeon immediately. You will probably need a decompression surgery as soon as possible. It is not a very major one in terms of morbidity. Though depending on the MRI the surgery may get revised. Meanwhile please take a few prescription medications like Pregabalin-M twice a day. This may make you a bit drowsy for the first few days, but you will slowly find yourself without the drowsiness after those days. I think a nerve biopsy too is warranted but can be done later if the neuropathy doesn't improve. But please take good care and see another neurosurgeon, the sooner the better.
If you have any more doubts or clarifications, you are always welcome.
Regards,
Pradeep
Above answer was peer-reviewed by :
Dr. Pradeep Vitta
Answered by
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