To anyone troubled by foot cramps...I found some very helpful info I'm =
going to pass along.
Gail Vass
Pharmacotherapy of Ancillary PD Symptoms
http://pharminfo.com/pubs/msb/pd_focus.html
PD patients have trouble with muscular function in general, which =
contributes to a variety of symptoms
other than tremor, rigidity and bradykinesia. PD patients are =
particularly bothered by dysphagia (drooling,
difficulty swallowing), nausea, delayed gastric emptying, and =
constipation. Foot cramps are another
debilitating condition. There are a number of remedies for these =
problems, some pharmacologic, some
not. For drooling and difficulty swallowing, sucking hard candy or =
chewing gum may facilitate the
swallow reflex. Anticholinergics are not recommended because they make =
the saliva sticky. Nausea,
delayed gastric emptying and constipation may respond to cisapride =
(Propulsid/Janssen), a prokinetic
agent that accelerates gastric emptying and colonic transit. Exercise =
and a high-fiber diet also help. There
are dopamine receptors in the gut, so delayed gastrointestinal transit =
may be due the same disease process
on a local level. =
For foot cramps, muscle relaxants such as cyclobenzaprine =
(Flexeril/Merck) and baclofen (Lioresal/Geigy)
may ease the pain. Since cramping can be due to either too much or too =
little dopamine (a peak-dose
dystonia or a wearing-off effect), changing the Sinemet dose or dosage =
schedule or using the sustained
release formulation may help. Some patients respond to the =
monoamine-oxidase B inhibitor selegiline
(Eldepryl/Somerset) or to the dopamine agonists bromocriptine or =
pergolide. Injections of botulinum
toxin (Botox/Allergan) into the cramping muscle can provide months of =
relief. (See also Parkinson's
Disease: Treating Foot Cramps). =
http://pharminfo.com/pubs/msb/pd_foot.html
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 =D2hammer toes,=D3 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).
