Kathy Greene wrote:
> My mother...just moved in with me...Foot cramps have been a major problem... Old neuro. said were part of PD...New neuro.said they are rarely part of PD...I thought I read that foot cramps, mainly at night and early am, were seen in PD. If that is so what is with this new (very young) neuro...he specializes in movement disorders.<
New and obviously inexperienced, this new MDS. Following is an article
that you should take to this fellow to read...
Parkinson's Disease: Treating Foot Cramps
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 -hammer
toes,- 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), 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) may also help.
A bedtime dose of Sinemet CR, pergolide (Permax), or bromocriptine
(Parlodel) may prevent foot dystonia during early-morning hours. Some
patients respond to anticholinergics such as trihexyphenidyl (Artane),
muscle relaxants such as cyclobenzaprine (Flexeril) and baclofen
(Lioresal), and the anticonvulsant clonazepam (Klonopin).
Another treatment giving excellent relief is botulinum toxin (Botox).
Injected into the dystonic or cramping muscle, botulinum toxin reduces
the intensity of the spasms; the effects may last months after
injection. 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.
(Reprinted from Medical Sciences Bulletin published by Pharmaceutical
Information Associates, Ltd.)
>Also...a nurse always returns calls, never the Doc. himself. Am I expecting too much?<
We, too, have a nurse working with our MDS and she usually returns any
phone calls. She is qualified and a member of the Movement Disorder
Clinic team.
Our new MDS is going through a learning experience (the hard way, I'm
afraid) but I feel if he is going to be of any help to us, he must learn
to listen to what we are telling him. We are not text book cases. No
Parkinsonian is because we are all different. If your new MDS isn't
prepared to listen and learn...get another neuro. WE are our own best
advocates. WE know how our systems are reacting to meds, and how
Parkinsons affects us.
BTW- I experience painful foot cramps, especially in the morning before
my meds kick in, but always in the non PD side.
Judith
--
Judith Richards, London, Ontario, Canada
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