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First, let me thank everyone for your love and concern. I haven't felt a bit good today, there is just something about lying on a hard cervical collar for 25 minutes with a neck which is sore,even to my touch, which doesn't lead to feeling great today, but I'm sure tomorrow I'll be just fine. Thanks! Then for PD: I put this in last week but maybe some of you missed it, are curled toes, and foot cramps the same thing? Could foot cramps cause curled toes later? just me, Marjorie Parkinson's Disease: Treating Foot Cramps Medical Sciences Bulletin Contents Parkinson's Disease: Treating Foot Cramps Reprinted from Medical Sciences Bulletin published by Pharmaceutical Information Associates, Ltd. Drugs mentioned: levodopa/carbidopa (Sinemet/Dupont-MSD) selegiline (Eldepryl/Somerset) pergolide (Permax/Lilly) bromocriptine (Parlodel/Sandoz) trihexyphenidyl (Artane/Lederle) cyclobenzaprine (Flexeril/Merck) baclofen (Lioresal/Geigy) clonazepam (Klonopin/Roche) botulinum toxin (Botox/Allergan). Aching and cramping of the feet are common complaints, often occurring after injury (strains and sprains) or excessive exercise, or in association with arthritis or poor circulation in the legs. In Parkinson's disease (PD), cramping of the feet is also very common, but the cause is central rather than peripheral. Foot cramping is just one of several focal dystonias -- abnormal, sustained tightening of muscles -- that appear to be due to neurochemical abnormalities in the basal ganglia, that part of the brain involved in PD. Patients show a particular type of cramping characterized by downward clenching of the toes or inward turning of the foot. Cramping can occur throughout the day or night, and can be especially annoying when it interferes with sleep. Foot cramping is more common among those individuals whose PD affects just one side of the body. Dystonias are often mistaken for other causes of cramping or painful muscles. Some individuals with orthopedic foot problems, such as Òhammer toes,Ó are actually suffering from Parkinsonian dystonia. Patients with dystonias may be entirely unaware of any Parkinsonism; indeed, muscle cramping can precede the onset of Parkinsonian symptoms by years. There are no laboratory tests that distinguish dystonia from other causes of cramping, although a thorough neurologic examination and specialized tests should pinpoint the cause. Some dystonic features -- such as blepharospasm (involuntary closing of the eyelids) or torticollis (involuntary turning of the neck) -- are common in the general population. In the PD patient receiving levodopa/carbidopa (Sinemet/DuPont Pharmaceuticals), focal dystonias may be caused by either too much of the drug or too little. Patients may experience dystonia when peak drug levels are attained 1 to 2 hours after administration, or hours later when drug effects wear off. Changing the dose or dosage schedule of Sinemet, or using the sustained-release product (Sinemet CR) may help. The monoamine-oxidase B inhibitor selegiline (Eldepryl/Somerset) may also help. A bedtime dose of Sinemet CR, pergolide (Permax/Lilly), or bromocriptine (Parlodel/Sandoz) may prevent foot dystonia during early- morning hours. Some patients respond to anticholinergics such as trihexyphenidyl (Artane/Lederle), muscle relaxants such as cyclobenzaprine (Flexeril/Merck) and baclofen (Lioresal/Geigy), and the anticonvulsant clonazepam (Klonopin/Roche). Another treatment giving excellent relief is botulinum toxin (Botox/Allergan). Injected into the dystonic or cramping muscle, botulinum toxin reduces the intensity of the spasms; the effects may last months after injec-tion. The toxin is also used for Parkinsonian tremors, benign essential tremor, and a number of dystonias not always associated with PD. These include blepharospasm, torticollis, dysphonia (cramping of the vocal cords), strabismus (wandering eye), stuttering, and large-muscle spasms associated with conditions such as stroke, head trauma, and multiple sclerosis. A careful evaluation of the temporal relationship between foot cramping and the levodopa dosage schedule should help the physician decide how best to treat this uncomfortable manifestation of PD. Modifying the levodopa regimen or adding other anti-PD agents can alter signals from the brain that trigger the contractions, or the muscle itself can be "paralyzed" with botulinum toxin. (LeWitt PA. UPF Newsl. 1993; #3: 3-4). Medical Sciences Bulletin Contents Pharmaceutical Information Associates Homepage PharmInfoNet Homepage