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Muscle Relaxers For Parkinson’s

Questions To Ask Your Doctor

Functional Neurological Disorder (FND) (conversion disorder) wiith Dystonia and Baclofen
  • My mother had cervical dystonia. Am I at risk of getting it? Can I pass it to my children?
  • Does cervical dystonia come on slowly or happen suddenly?
  • How can physical therapy help cervical dystonia?
  • What are the side effects of medicines that treat cervical dystonia?
  • Will I need surgery to treat this condition? If so, what are the side effects?

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Involuntary Trembling Or Shaking

A tremor is an involuntary, repetitive muscle movement that may result from a neurologic disease, the use of a medication, an inherited condition, or an unknown cause. Tremors take many forms, including rocking motions, fine rhythmic motions, coarse back-and-forth movements, and twisting or repeated shaking. Tremors may affect the muscles in the extremities, trunk, head, face, or larynx.

The most common type of tremor is benign essential tremor. Essential tremor, which has no known cause, is often inherited and typically occurs in older adults. The hands are most often affected, although the head, tongue, voice, trunk, or legs may be involved. The tremor may remain mild or progress to the point of interfering with simple activities such as walking or writing. Many people feel self-conscious about their tremor and restrict their activities as a result.

Drug Used To Treat Parkinson’s Disease May Be Beneficial In Treating Fibromyalgia

John Wiley & Sons, Inc.
Recently, researchers set out to investigate whether the dopamine receptor agonist pramipexole was safe and effective in treating fibromyalgia. Normally used to treat Parkinson’s disease, this drug stimulates dopamine production by binding to dopamine receptor sites and is thought to inhibit sensory nerve-mediated responses. This is the first trial of pramipexole and only the second trial for this type of dopamine receptor agonist for the treatment of fibromyalgia.

The mechanism of fibromyalgia, a chronic illness characterized by muscle pain, fatigue, and sleep disturbances, is unknown and medications used to treat it have had limited success. New research findings indicate that the pain associated with this disease may be due to abnormal sensory processing in the central nervous system.

Recently, researchers from Pacific Rheumatology Associates in Renton, Washington set out to investigate whether the dopamine receptor agonist pramipexole was safe and effective in treating fibromyalgia. Normally used to treat Parkinson’s disease, this drug stimulates dopamine production by binding to dopamine receptor sites and is thought to inhibit sensory nerve-mediated responses. This is the first trial of pramipexole and only the second trial for this type of dopamine receptor agonist for the treatment of fibromyalgia. The findings are published in the August 2005 issue of Arthritis & Rheumatism .

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What Do Muscle Relaxers Do

Muscle relaxants can help relieve pain and other symptoms caused by muscle spasms and spasticity. They are unique because scientists and doctors still dont understand how many of them work.

There are two categories of muscle relaxants:

  • Antispasmodics also known as centrally acting skeletal muscle relaxants are used, along with rest and physical therapy, to relieve muscle spasms.
  • Antispastics are used to treat muscle spasticity, and shouldnt be used to treat spasms.

Doctors believe that spasms are caused by your nerves sending an excessive amount of signals to your brain. Muscle relaxants reduce the number of signals sent between your nerves and your brains. This is commonly referred to as a sedative effect.

A Critical Reappraisal Of The Worst Drugs In Parkinsons Disease

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What are the worst drugs for Parkinsons disease patients? Couldnt a simple list be assembled and disseminated to the Parkinson community? Recently Ed Steinmetz, an experienced neurologist in Ft. Meyers, FL pointed out to me, a list approach published in the Public Citizen Newsletter . The approach was to list every drug associated with a single confirmed or unconfirmed symptom of Parkinsons disease or parkinsonism. Parkinsons disease is defined as a neurodegenerative syndrome , whereas parkinsonism encompasses a wider net of drug induced and other potential causes. In parkinsonism symptoms are similar to Parkinsons disease, but patients do not have Parkinsons disease. Patients and family members confronted with a simple drug list approach may falsely conclude that most medicines are bad for Parkinsons disease, and that any medicine may cause parkinsonism. This concept is in general, incorrect. Although the approach is well-meaning, it is in need of a major revision, as Parkinsons disease and parkinsonism are too complex to summarize by simple lists. In this months column I will try to summarize the key information that patients and family members need to know about the worst pills, for Parkinsons disease and parkinsonism.

A Florida Parkinsons Treatment Blog by Michael S. Okun, M.D.

UF Center for Movement Disorders & Neurorestoration, Gainesville FL

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Why Does Dystonia Occur In Parkinsons Disease

Dystonia in PD is commonly associated with the Wearing Off of the effects of levodopa containing medications , in which the drug treatment becomes ess effective before the next dose of the Sinemet, Madopar or Stalevo is due. This effect is known as Off dystonia and can often occur in the morning on waking up. A person can experience painful muscular spasms and may be unable to get out of bed until the mornings dose of medication begins to take effect. Off dystonia can sometimes be managed by taking a controlled-release levodopa preparation which releases the drug over a four to six-hour period at night, but you should discuss this possibility with your GP or specialist.

Dystonia in PD can also be associated with the action of levodopa itself as the medication reaches its peak effectiveness. This is known as On dystonia and is caused by too much dopamine in the brain over-stimulating the muscles

Finally, dystonia in PD may be unrelated to the dose of levodopa and can occur as a feature of the condition itself. This can happen at any time of the day, but is usually briefer than dystonias related to levodopa.

What Parts Of The Body Are Affected By Dystonia

Dystonia is usually worse on the side of the body where the PD symptoms are more pronounced. It can be localised to a single muscle or to a group of muscles, but in people with PD it is most commonly seen in the feet. Spasms in the calf muscles can cause the toes to curl into a claw-like position. The foot may also turn in at the ankle and sometimes the big toe can stick up . This can be very uncomfortable, especially for people who try to fit their feet into tight-fitting shoes. Although most common in the feet, dystonia can occur in other parts of the body.

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Other Less Frequent Dystonic Effects Found In Pd Include The Following:

  • A spasm of the hand, often provoked by tasks requiring fine motor control such as handwriting. For this reason it is known as writers cramp and can often begin as a tremor of the hand
  • Cervical dystonia or spasmodic torticollis, which is a sustained turning of the head to one side, bending forward or, more rarely, backward
  • Blepharospasm, meaning intermittent or sustained eyelid closure caused by the contraction of the eyelid muscles. This can begin in one eye, but will usually continue on to the other eye. Symptoms of this condition include excessive blinking, irritation, a burning sensation in the eyes and photophobia, an abnormal intolerance to light. These symptoms can be aggravated by stress, looking up or down, reading, driving or bright lights
  • Spasmodic dysphonia or a spasm of the vocal cords
  • Hemimasticatory or hemifacial spasm, a spasm affecting one side of the jaw area or one side of the face

Warnings For People With Certain Health Conditions

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For people with open-angle glaucoma: You should not use trihexyphenidyl if you have open-angle glaucoma because it may cause blindness. Your doctor should do an eye exam before starting you on this drug to make sure your eye sight is okay.

For people with liver disease: If you have liver disease, your body may not be able to process this drug well. This can cause an increase in the levels of this drug in your body. This can raise your risk of side effects.

For people with heart disease: If you have heart disease, you may be at an increased risk for angina or tachycardia . Your doctor may want to monitor you more closely for side effects and start you on a lowered dosage to see how you respond.

For people with kidney disease: If you have kidney problems or a history of kidney disease, you may not be able to clear this drug from your body well. This may increase the levels of this drug in your body and cause more side effects. Your doctor may monitor you more closely for side effects.

For people with high blood pressure: You may be at increased risk for angina , a heart attack, or tachycardia . Your doctor may monitor you more closely for side effects and start you on a lower dosage to see how you respond.

All possible dosages and drug forms may not be included here. Your dosage, drug form, and how often you take the drug will depend on:

  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

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More Common Side Effects

Some of the more common side effects that can occur with use of trihexyphenidyl include:

  • fast and shallow breathing
  • high or low blood pressure
  • Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

    Medication Guidelines For Parkinson’s Disease

    There is no one best mix of Parkinsonâs medicines. You and your doctor will have to try a few treatment approaches to figure out the best one for you.

    But there are some general guidelines for taking your medication. Be sure to ask your doctor or pharmacist for any specific tips for your treatment.

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    Common Drugs For Parkinson’s Disease

    Levodopa and carbidopa . Levodopa is the most commonly prescribed medicine for Parkinsonâs. Itâs also the best at controlling the symptoms of the condition, particularly slow movements and stiff, rigid body parts.

    Levodopa works when your brain cells change it into dopamine. Thatâs a chemical the brain uses to send signals that help you move your body. People with Parkinsonâs donât have enough dopamine in their brains to control their movements.

    Sinemet is a mix of levodopa and another drug called carbidopa. Carbidopa makes the levodopa work better, so you can take less of it. That prevents many common side effects of levodopa, such as nausea, vomiting, and irregular heart rhythms.

    Sinemet has the fewest short-term side effects, compared with other Parkinsonâs medications. But it does raise your odds for some long-term problems, such as involuntary movements. An inhalable powder form of levodopa and the tablet istradefylline have been approved for those experiencing OFF periods, OFF periods can happen when Parkinsonâs symptoms return during periods between scheduled doses of levodopa/carbidopa.

    People who take levodopa for 3-5 years may eventually have restlessness, confusion, or unusual movements within a few hours of taking the medicine. Changes in the amount or timing of your dose will usually prevent these side effects.

    Dopamine agonists. These drugs act like dopamine in the brain. They include pramipexole , rotigotine , and ropinirole , .

    Trihexyphenidyl May Interact With Other Medications

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    Trihexyphenidyl oral tablet can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

    To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs youre taking. To find out how this drug might interact with something else youre taking, talk to your doctor or pharmacist.

    Examples of drugs that can cause interactions with trihexyphenidyl are listed below.

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    When To Contact A Doctor

    Anyone with muscle spasms and pain should consult a doctor, who may prescribe or recommend a muscle relaxer. It is important to be aware of the possible side effects.

    While an OTC muscle relaxer exists, it may not be appropriate for all types of muscle conditions. Contact a doctor or speak with a pharmacist before taking any muscle relaxer.

    Talk With Your Doctor

    Its important to treat both spasticity and muscle spasms. Severe, long-term spasticity can lead to muscle contracture, which can decrease your range of motion or leave the affected joints permanently bent. And muscle spasms can not only be uncomfortable, they can also be a sign of an underlying medical problem.

    Your muscle spasms or spasticity are likely treatable with rest, physical therapy, medications, or all of the above. Work with your doctor to put together a care plan that can ease your pain and get you moving comfortably again.

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    How Should I Take Pramipexole

    Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed.

    If you are taking immediate-release pramipexole you should not take extended-release pramipexole at the same time.

    The dose and timing of pramipexole in treating Parkinsons disease is different from the dose and timing in treating RLS. Follow the directions on your prescription label. Ask your pharmacist if you have any questions about the kind of pramipexole you receive at the pharmacy.

    Pramipexole can be taken with or without food. Take the medication with food if it upsets your stomach.

    Do not crush, chew, or break an extended-release tablet . Swallow it whole.

    If you are taking this medication for RLS, tell your doctor if your symptoms get worse, if they occur in the morning or earlier than usual in the evening, or if you feel restless symptoms in your hands or arms.

    Do not stop using pramipexole suddenly, or you could have unpleasant withdrawal symptoms. Follow your doctors instructions about tapering your dose.

    Store at room temperature away from moisture, heat, and light.

    What Is A Muscle Relaxer


    Muscle relaxers, or muscle relaxants, are medications that treat muscle spasms or muscle spasticity by decreasing the bodys muscle tone.

    • Muscle spasms, commonly referred to as cramps, are quick and unexpected contractions of a muscle or group of muscles.
    • Muscle spasticity is a continuous spasm that causes muscle stiffness or tightness.
    • Muscle tone refers to the muscles resistance to stretch in a relaxed state.

    Skeletal muscle spasms are the most common type of cramp and come from overuse, muscle fatigue, dehydration, or electrolyte abnormalities. Spasms are usually abrupt, painful, and short-lived.

    Causes of Muscle Spasms

    Conditions that lead to muscle spasms include:

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    How Can You Improve Aggressiveness And Hallucinations In Parkinsons

    Hallucinations may spark anger or aggression in a person with Parkinsons disease. Some ways to help include:

    • Reassure them, tell them they are safe.
    • Speak slowly and calmly.
    • Ask questions about the persons feelings.
    • Listen to the person, dont interrupt.
    • Avoid sudden movements.
    • Give the person space and a way out, so they dont feel cornered or threatened.
    • Make an emergency plan ahead of time for what you and others in the house will do if the person experiencing hallucinations becomes a danger to themselves, you, or anyone else.
    • When it is safe, help the person speak with their healthcare provider about making a plan to address the hallucinations.

    Muscle Relaxers For Neck & Back Pain

    Back pain is the number one ailment that calls for a muscle relaxant prescription. Neck pain, upper back pain, and lower back pain can be caused by, or be the cause of, tense or spasming muscles.

    Doctors always prescribe muscle relaxants in conjunction with rest and physical therapy. Doctors may use them early on to reduce pain associated with muscle spasms. Although muscle relaxers work no better than non-steroidal anti-inflammatory drugs in pain relief, doctors still prescribe them. This is due to their added sedative befits, which often helps a person rest.

    Muscle relaxers can also help treat restless leg syndrome and sore muscles.

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    Antispasmodics: Centrally Acting Skeletal Muscle Relaxants

    Centrally acting SMRs are used in addition to rest and physical therapy to help relieve muscle spasms. Theyre thought to work by causing a sedative effect or by preventing your nerves from sending pain signals to your brain.

    You should only use these muscle relaxants for up to 2 or 3 weeks. The safety of longer-term use is not yet known.

    While antispasmodics can be used to treat muscle spasms, they have not been shown to work better than nonsteroidal anti-inflammatory drugs or acetaminophen. In addition, they have more side effects than NSAIDs or acetaminophen.

    The more common side effects of centrally acting SMRs include:

    Medications For Other Symptoms

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    There are a number of Parkinsons symptoms not directly related to movement known as non-motor symptoms. Non-motor symptoms include a wide variety of problems ranging from difficulty with sleeping, depression, apathy and anxiety, changes in cognition and gastrointestinal issues such as constipation and urinary dysfunction. Parkinsons medications typically dont directly address these symptoms, but the way medications can improve your ability to move may have secondary benefits that help with non-motor symptoms. For example, if a medication like carbidopa/levodopa allows for more activity and exercise, this often results in better sleep function as well as gastrointestinal health.

    However, in situations where there is a troubling non-motor symptom, it is often best to have a conversation with your doctor to see if there are medications that can relieve some of these challenges. For example, your doctor may recommend a medication to address a symptom like depression or neurogenic orthostatic hypotension that may provide direct relief to that specific symptom.

    In addition, over-the-counter options or other complementary therapies like acupuncture may provide relief for certain symptoms and can often be combined with simple lifestyle modifications to make significant improvements in many non-motor symptoms. For instance, increasing the amount of fluid you drink and the amount of fiber you eat may help alleviate troublesome constipation.

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