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What Causes Dyskinesia?
Question: HI DOCTOR I AM A GEN. MED. PRACTITIONER FOR LAST 50 YRS SINCE 1964... I AM EXPERIENCING PD TYPE SYMPTOMS SINCE LAST 4/5 YRS SUCH AS IMBALANCE , FREEING GAIT SYMPTOMS. DYSKINESIA, SLOW SPEECH MOSTLY INAUDIBLE, STOOPING GAIT , HANDWRITING WORST [ it was very nice before ] TRMOURS ONLY IN RT UPPER EXTREMITY WHEN TELLNG SOME OTHER PERSON OR UNDER TENSION . OTHERWISE NO TREMOURS THIS ALSO I CAN CONTROL BY HOLDING MY HAND NOW I CANT WALK WITHOUT SUPPORT .
I AM ALSO A PT. OF DM N HT BOTH UNDER CONTROL WITH MINIMUM MED AS ATEN 50MG OD N METFOMI N 500MG BD I AM ALSO TAKING SYNDOPA PLUS 1 BD MY NEUROLOGIST HAD INCREASED THE DOSE UPTO 8 TAB PER DAY 2 QID BUT THERE WAS NO EFFECT THERE IS NEVER OF N ON POSITION . HE SAYS THAT THIS NOT A CASE PACCA PD BUT PD PLUS THERE IS NEVER CONSTIPATION , NO OLFACTORY CHANGES, I AM VERY GOOD AT MEMORY, NO COGNITIVE CHANGES,I CAN PLAY BRIDGE AND CHESS WELL,
NOW I AM SUFFERING FROM PAIN AT BOTH LOWER EXTRE\. WHILE SLEEPING I CANT CHANGE MY SIDE WITHOUT HAVING PAIN VERY VERY PAINFUL BOTH LATERAL SIDES OF MY THIGHS N BOTH HIP JOINTS I SAW ORTHO. HE HAS GIVEN LONG LIST OF MED, WHICH IS MOSTLY SUIPPLIMENTAL LIKE BCOMPLEX CALCIUM VIT C VIT E N SPECIFIC ONES R TENDOFIT. CELEDREN PALSINURON
BUT NO ANALGESICS ONLY SOME AYRVEDIC OIL TO APPLY
I AM 74 YRS OLD WT 70 KG HT IS 5 FT AND 6 INCHES PLEASE LET ME KNOW WHETHER I CAN START ROPARK OR AMANATIDINE I HAE FALLEN MANY TIMES BUT BY LUCK NO HIP FRACTURE REPLY I AM WAITING EAGERLY THANKS XXXXX MOB 020-0000 MY EMAIL ADD IS YYYY@YYYY
I AM ALSO A PT. OF DM N HT BOTH UNDER CONTROL WITH MINIMUM MED AS ATEN 50MG OD N METFOMI N 500MG BD I AM ALSO TAKING SYNDOPA PLUS 1 BD MY NEUROLOGIST HAD INCREASED THE DOSE UPTO 8 TAB PER DAY 2 QID BUT THERE WAS NO EFFECT THERE IS NEVER OF N ON POSITION . HE SAYS THAT THIS NOT A CASE PACCA PD BUT PD PLUS THERE IS NEVER CONSTIPATION , NO OLFACTORY CHANGES, I AM VERY GOOD AT MEMORY, NO COGNITIVE CHANGES,I CAN PLAY BRIDGE AND CHESS WELL,
NOW I AM SUFFERING FROM PAIN AT BOTH LOWER EXTRE\. WHILE SLEEPING I CANT CHANGE MY SIDE WITHOUT HAVING PAIN VERY VERY PAINFUL BOTH LATERAL SIDES OF MY THIGHS N BOTH HIP JOINTS I SAW ORTHO. HE HAS GIVEN LONG LIST OF MED, WHICH IS MOSTLY SUIPPLIMENTAL LIKE BCOMPLEX CALCIUM VIT C VIT E N SPECIFIC ONES R TENDOFIT. CELEDREN PALSINURON
BUT NO ANALGESICS ONLY SOME AYRVEDIC OIL TO APPLY
I AM 74 YRS OLD WT 70 KG HT IS 5 FT AND 6 INCHES PLEASE LET ME KNOW WHETHER I CAN START ROPARK OR AMANATIDINE I HAE FALLEN MANY TIMES BUT BY LUCK NO HIP FRACTURE REPLY I AM WAITING EAGERLY THANKS XXXXX MOB 020-0000 MY EMAIL ADD IS YYYY@YYYY
Brief Answer:
Parkinsonism and its therapy
Detailed Answer:
Hi,
Thank you for your query. I can understand your concerns.
In general, dopamine agonists do not have comparable efficacy to levodopa.
Dopamine agonists (pramipexole, ropinirole) are relatively long-acting and are less prone than levodopa to induce dyskinesia. For this reason, many physicians initiate therapy with a dopamine agonist, although supplemental levodopa is eventually required in virtually all patients.
While some physicians use amantadine in patients with early disease for its mild symptomatic effects, it is most widely used as an antidyskinesia agent in patients with advanced PD.
You can add Ropark (ropinirole)as adjuncts to levodopa to enhance motor function and reduce "off" time. Ropinirole is also indicated in restless leg syndrome.
Amantadine is unlikely to help at this stage.
Regards
Dr. T.K. Biswas M.D. XXXXXXX
Parkinsonism and its therapy
Detailed Answer:
Hi,
Thank you for your query. I can understand your concerns.
In general, dopamine agonists do not have comparable efficacy to levodopa.
Dopamine agonists (pramipexole, ropinirole) are relatively long-acting and are less prone than levodopa to induce dyskinesia. For this reason, many physicians initiate therapy with a dopamine agonist, although supplemental levodopa is eventually required in virtually all patients.
While some physicians use amantadine in patients with early disease for its mild symptomatic effects, it is most widely used as an antidyskinesia agent in patients with advanced PD.
You can add Ropark (ropinirole)as adjuncts to levodopa to enhance motor function and reduce "off" time. Ropinirole is also indicated in restless leg syndrome.
Amantadine is unlikely to help at this stage.
Regards
Dr. T.K. Biswas M.D. XXXXXXX
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
dear doctor thanks for ur prompt answer i want to know whether it is PD or not , l secondly what is my hip joint pain and the pains along the lateral aspect of both thighs at night only it is due to rigidity or what ?
i dont have ON N OFF time whether i take dopamine or not . still i will try what u said to try ropark regards XXXX
i dont have ON N OFF time whether i take dopamine or not . still i will try what u said to try ropark regards XXXX
Brief Answer:
Parkinsonism- symptoms ,diagnosis & co-morbities
Detailed Answer:
Hi,
Thank you for your query. I can understand your concerns.
Essentials of diagnosis OF Parkinsonism "TRAP"-Any combination of tremor(T), rigidity( R),akinesia/ bradykinesia (A), progressive postural instability(P).
A stoop is characteristic.
Rest tremor is virtually pathognomonic of Parkinson's disease.
The tremor is invariably more severe in the arm than in the leg. Commonly confined to one limb or one side(unilateral) for months or years before becoming more generalized.
Enhanced by stress(tension as you mentioned)
Emotional stress augments the amplitude (as you speak to others about your ailment).
Parkinsonian tremor is reduced by voluntary movement (holding your hand).
Speech is often feeble, slow (Bradylalia),slurred because of the muscular rigidity and immobility of the lips and tongue.
Hand writing becomes small (micrographia) and spidery, and tends to tail off (deterioration of your handwriting).
Freezing usually begins with start- hesitation but often, patients develop destination-freezing, that is, stopping before reaching the final destination.
With further progression, sudden transient freezing can occur when the patient is walking in an open space or when he perceives an obstacle in his walking path.
PD is usually associated with mild intellectual deterioration (Subcortical dementia).
No doubt you have Parkinsonism .
Diagnosis of Parkinsonism is usually made on clinical grounds. Investigations may be required in exceptional situations.
MRI of the brain is seldom necessary in a typical case.
'parkinsonism-plus syndromes' is suspected when
1. Falls or dementia early in the course of the disease
2. Prominent akinesia and rigidity without tremor at onset.
3. Symmetric parkinsonism
4. Wide-based gait
5. Abnormal eye movements
6. Babinski's signs
7. Marked orthostatic hypotension
8. Urinary retention, and
9. The development of marked disability within five years after the onset of the symptoms (rapid progression).
10. Development of neurological signs indicating disease out-side the basal ganglia.
Your hip joint pain is due to co-morbidities most likely osteoarthritis,not uncommon at your age. X-ray of Hip joint will help to reach a diagnosis of painful hip joint.
The rigidity of Parkinson's disease may be experienced as stiffness associated with vague aching and discomfort of a limb suggesting musculoskeletal syndromes, particularly bursitis and tendinitis.
Hope I have been able to address your concerns and queries.
Regards
Dr. T.K. Biswas M.D. XXXXXXX
Parkinsonism- symptoms ,diagnosis & co-morbities
Detailed Answer:
Hi,
Thank you for your query. I can understand your concerns.
Essentials of diagnosis OF Parkinsonism "TRAP"-Any combination of tremor(T), rigidity( R),akinesia/ bradykinesia (A), progressive postural instability(P).
A stoop is characteristic.
Rest tremor is virtually pathognomonic of Parkinson's disease.
The tremor is invariably more severe in the arm than in the leg. Commonly confined to one limb or one side(unilateral) for months or years before becoming more generalized.
Enhanced by stress(tension as you mentioned)
Emotional stress augments the amplitude (as you speak to others about your ailment).
Parkinsonian tremor is reduced by voluntary movement (holding your hand).
Speech is often feeble, slow (Bradylalia),slurred because of the muscular rigidity and immobility of the lips and tongue.
Hand writing becomes small (micrographia) and spidery, and tends to tail off (deterioration of your handwriting).
Freezing usually begins with start- hesitation but often, patients develop destination-freezing, that is, stopping before reaching the final destination.
With further progression, sudden transient freezing can occur when the patient is walking in an open space or when he perceives an obstacle in his walking path.
PD is usually associated with mild intellectual deterioration (Subcortical dementia).
No doubt you have Parkinsonism .
Diagnosis of Parkinsonism is usually made on clinical grounds. Investigations may be required in exceptional situations.
MRI of the brain is seldom necessary in a typical case.
'parkinsonism-plus syndromes' is suspected when
1. Falls or dementia early in the course of the disease
2. Prominent akinesia and rigidity without tremor at onset.
3. Symmetric parkinsonism
4. Wide-based gait
5. Abnormal eye movements
6. Babinski's signs
7. Marked orthostatic hypotension
8. Urinary retention, and
9. The development of marked disability within five years after the onset of the symptoms (rapid progression).
10. Development of neurological signs indicating disease out-side the basal ganglia.
Your hip joint pain is due to co-morbidities most likely osteoarthritis,not uncommon at your age. X-ray of Hip joint will help to reach a diagnosis of painful hip joint.
The rigidity of Parkinson's disease may be experienced as stiffness associated with vague aching and discomfort of a limb suggesting musculoskeletal syndromes, particularly bursitis and tendinitis.
Hope I have been able to address your concerns and queries.
Regards
Dr. T.K. Biswas M.D. XXXXXXX
Above answer was peer-reviewed by :
Dr. Shanthi.E
Answered by
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