Hello Brian ,
Maybe you will find interest in the article below :
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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
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Best wishes ,
Joao Paulo.
Brian Collins wrote:
> On Sun 21 Nov, Joao Paulo Carvalho wrote:
> > Hi Clare,
> >
> > Excuse me if I missed something ... but how about those cramps that are produced
> > by doing long or heavy exercises without being well fitted for their practice ,
> > else the caused by a thermal shock , etc.? I suppose these are not related to
> > the brain behavior ....
> > Would dystonia include cramps ?
> >
> > Best wishes,
> >
> > Clare Wilson wrote:
> >
> > > In a message dated 11/20/99 10:13:51 AM Mountain Standard Time,
> > > [log in to unmask] writes:
> > >
> > > << by a sustained muscle contraction, frequently causing twisting and
> > > repetetive movements or abnormal postures and CAUSED BY INAPPROPRIATE
> > > INSTRUCTIONS FROM THE BRAIN. Unquote
> > > >>
> > > Brian, did you read Dr. Fink's statement in the archives: "Dystonia has
> > > little
> > > to do with muscles other than the fact that the muscles are affected. The
> > > cause
> > > of dystonia is 'central,' an imbalance between the excitatory and inhibitory
> > > motor systems within the brain. With few exceptions, the treatment of
> > > dystonia is in the brain: i.e., surgery on the brain or drugs which affect
> > > the
> > > brain...."
> >
> > --
> > +----| Joao Paulo de Carvalho |------ +
> > | [log in to unmask] |
> > +--------| Salvador-Bahia-Brazil |------+
> >
> >
> >
> Hello Joao Paulo, seems a long time since we met (Not such a happy subject)
> I am finding lots of references since I thought I had made a break-through,
> but at least I can still put 2 and 2 together and make 22 !
> Whoever asked the question above, the answer is NO: Dystonia does not include
> cramps.
>
> --
> Brian Collins <[log in to unmask]>
--
+----| Joao Paulo de Carvalho |------ +
| [log in to unmask] |
+--------| Salvador-Bahia-Brazil |------+
