What Are The Current Treatment Approaches
As with so many aspects of Parkinsons, there is no one size fits all approach for treating dystonia, but there are a range of things that can be helpful, including:
- Adjusting Parkinsons medication. This may include using fast-acting or longer-acting drugs, which can be effective if people experience dystonia primarily when their Parkinsons medication wears off.
- Non-drug approaches. Some people may also find that being relaxed helps with their dystonia. What makes someone relax differs from one person to the next, but you may find having a warm bath or massage helpful, or trying complementary therapies such as yoga.
- Other drug treatments. There are a range of different drugs that can be used to help to relax muscles, and in some cases Botulinum Toxin injections can be helpful.
- Surgery. Surgery for dystonia is not common, but may be considered if you dont respond to drug treatment. Surgical procedures that are already used for Parkinsons, such as deep brain stimulation, have been shown to help dystonia.
What Are The Causes Of Dystonia
Dystonia is usually linked to a disturbance in the part of the brain that controls movement.
Dystonia is common in the general population. However, in people living with Parkinsons disease, it is most often associated with the amount of levodopa in your body.
Dystonia usually occurs when the effect of one dose of levodopa wears off, before the next dose is taken. For example, you may wake up in the morning with a twisted body part . This painful twisting may prevent you from getting out of bed before the morning dose starts to take effect. This dystonia is called OFF dystonia. It is related to a lack of levodopa.
More rarely, dystonia can also be caused by brain over-stimulation with levodopa. This is called ON dystonia. It is related to excess dopamine. This type of dystonia is similar to dyskinesias, which may involve larger uncontrollable body movements. The characteristics of dystonia and dyskinesia may seem similar but you need to be able to differentiate between them because their treatments are different.
Dystonia may also be a specific symptom of Parkinsons disease unrelated to levodopa use. Foot dystonia may be the first motor symptom, especially in young people.
Dystonia usually occurs on the side of your body most affected by Parkinsons disease.
Legs and feetSpasms in the calf muscles can cause your toes to curl under your foot or your big toe to stretch. Your foot may also roll back toward your ankle.
Dystonia And Pain Management For Parkinson’s
Movement disorder specialist Alfonso Fasano, MD, PhD, outlines how to tease apart whether pain is a symptom of PD or due to an orthopedic issue. He explains how to approach the treatment of pain in concert with your medical team, going over several treatment options. Finally, Dr. Fasano focuses on causes of and treatments for dystonia and dyskinesias. After a 40-minute talk he spends 30 minutes answering questions.
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How Can I Reduce My Muscle Cramps
Cramps can result from excess or lack of movement. Some cramps may be connected to particular positions, such as at night, or specific activities. By avoiding these situations, you can reduce the occurrence of these cramps.
Cramps may also be related to a lack of hydration and vitamin B. Drink more fluids and consult your doctor to assess whether you need to take vitamin supplements.
You can also try to:
- Stretch longer before your daily activities
- Massage your muscles
How Do Methamphetamines Cause Parkinsons Disease
Parkinsons disease is caused by the death of a region of the nervous system known as the substantia nigra. This part of the brain both produces and releases the neurotransmitter dopamine. Since dopamine is so closely tied with the primary functions of the nervous system as they relate to coordination and movement, a permanent dopamine deficiency can lead to the same progressive and chronic symptoms that characterize Parkinsons disease.
Researchers have long known from non-human animal studies that methamphetamine induces cell death within the substantia nigra, though only recently have studies been able to verify the correlation to any large degree. One of the animal studies conducted in the mid-1990s indicated a total reduction in dopamine within the substantia nigra in laboratory mice of 40-45 percent within one week of exposure to methamphetamine.
A similar study on mice demonstrated that just three dose-proportioned methamphetamine injections set at three-hour intervals produced a fairly immediate reduction in dopaminergic cells of between 20 and 25 percent.
Observable significant increases in microglial cells, designed to protect the nervous system, are seen within the substantia nigra within hours after methamphetamine exposure, indicating some level of neurotoxicity.
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What Dystonia Looks Like In Pd
The involuntary muscle movements of dystonia can be subtle or very noticeable. They may manifest as:
Blepharospasm , squinting or repeated blinking
Grimacing or repeated jaw clenching
Thin, hoarse or shaky voice
Twisting of the neck into an abnormal posture
Twitching and cramping of the hands, fingers, feet or toes
If you experience symptoms of cervical dystonia, you should notify your doctor right away. Keeping a log of your dystonia symptoms can be helpful in finding the right treatment.
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Parkinson’s Disease: Early Signs
Alexander BruniTime for reading:
Learn about the symptoms that may indicate Parkinson’s disease. The health of your elderly relatives depends on your attention.
Learn about the symptoms that may indicate Parkinson’s disease. The health of your elderly relatives depends on your attention.
Parkinson’s disease mainly affects the elderly. This is a chronic disease in which neurons of the substantia nigra of the midbrain and other parts of the nervous system are destroyed. This disease develops as a result of a lack of the neurotransmitter dopamine.
The symptoms of this disease were described several thousand years ago. One of the pharaohs of Ancient Egypt was diagnosed with parkinsonism – hand tremors and movement limitations. In 1817, the English doctor James Parkinson published his “Essay on Trembling Paralysis”, in which he described in detail the symptoms of six patients. And in the second half of the 19th century, the French neurologist Jean Charcot suggested calling such a disorder Parkinson’s disease.
Today, Parkinson’s disease is the most common neurodegenerative disease after Alzheimer’s disease. The incidence of the disease varies from 60 to 140 patients per 100 thousand population. If we consider only elderly people over 60 years old, the percentage of patients is 1%, over 85 years old – up to 4%. Moreover, men suffer from this disease more often than women.
More severe symptoms include:
THIS IS NOT THE END OF THE ARTICLE
How Does Dystonia Usually Affect People With Parkinsons
Dystonia can affect people with Parkinsons in different ways at different times.
Some people with young onset forms of the condition, may experience dystonia as one of their first symptoms. Often the dystonia affects the feet and causes them to turn inwards and is exertion-induced, so people may find get it in their feet after running or walking.
Other people may experience dystonia during off periods when the effects of their Parkinsons medication wear off.
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Pain Is A Common But Overlooked Problem In Parkinsons Disease
Pain is an often overlooked non-motor symptom of Parkinsons disease . Studies show that between 40-80% of people with PD report pain, which is likely why it is often suggested as a topic for this blog.
One of the reasons why the topic of pain and PD is difficult to address is that it is sometimes tough to discern whether a particular pain is due to PD or not. Chronic pain is such a common symptom among the general population, and people with PD are not immune to common problems as well. However, there are aspects of PD that may exacerbate the pain experienced from a common problem. In addition, there are particular types of pain that may be unique to people with PD.
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What Dystonia Treatments Are Available
To start treatment, your neurologist will likely first optimize your levodopa treatment. They may change your intake time, the doses, or the type of medication you are taking.If your dystonia does not respond to changes in your antiparkinsonian medications, your neurologist may prescribe medications that act as muscle relaxants such as clonazepam , or anticholinergic medications such as trihexyphenidyl and procyclidine.Botulinum toxin, commonly known as Botox, can also help treat dystonia in some people. It involves injections in the affected muscle to block abnormal signals from the brain. Botox also weakens the affected muscle, which helps to relieve pain. For an optimal and sustained effect, injections are repeated regularly, usually every three months.
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Impaired Posture And Balance
Postural instability is the most difficult Parkinsons symptom to treat, and one of the most important criteria for diagnosing Parkinsons.
Postural instability is the inability to balance due to loss of postural reflexes and often leads to falls. Patients with impaired posture and balance might revert to a stooped posture and have a shuffling gait.
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Tips For Dealing With Chronic Pain
Chronic pain is one that last more than 3-6 months , or pain that extends behind the expected period of healing. This blog post explains the different types of pain caused by Parkinsons disease and how to address pain brought on by the disease, by medications, or by comorbid disease. It is always best to treat pain before it becomes chronic.
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When Can Dystonia Occur
Each persons experience with Parkinsons and dystonia is unique. Dystonia can occur unexpectedly or during repetitive actions, such as writing or golfing. It can be brief or prolonged. It can occur as a response to your levodopa therapy, even if your medication is working optimally. And, it can occur at different times throughout the day or can be cyclical.
How Is Dystonia Diagnosed
Your doctor will perform a detailed physical exam to identify symptoms of the disorder. He or she will also take a medical history and family history in case the condition might have a genetic component. If the dystonia is suspected to be inherited, genetic testing may be used to confirm the diagnosis.
Blood or urine tests may be conducted to evaluate for the possibility of associated diseases or conditions. Imaging may be recommended to look for underlying structural injuries in the brain.
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What Treatment Options Are Available For Dystonia
Personalized treatment based on each patients condition brings the best results as there are no treatments yet available to cure the condition. Treatment options include the following:
- Oral medications: Your doctor may prescribe a medication that acts on neurotransmitters, based on your symptoms. Options include drugs that act on the neurotransmitter GABA and drugs that affect dopamine levels.
- Botulinum toxin: For prominent dystonia in one particular body part, doctors may try botulinum injections in small amounts in the affected muscles, which can bring significant but temporary relief.
- Deep brain stimulation surgery: This surgical procedure involves inserting small electrodes into your brain. These send pulses of electricity into the specific areas of the brain that control movement in the affected body part. DBS surgery is usually considered only after all other treatment possibilities have been exhausted but can be effective in appropriate cases.
Identify The Cause Of The Pain
The first step in treating pain is to try to identify the cause. As I noted in the last essay, there are many different causes of pain for people with PD. If we look at the most common pain problems, low back and neck pain, we can see that there are many different causes for each. Many doctors order x-rays of the spine for these conditions, and they may be needed. The main problem with x-rays of the spine is that they always show arthritis, which is because virtually everyone over the age of 60 has arthritis in the spine. Whether thats the cause of the pain or not is usually not clear.
However, x-rays will show if theres a compression fracture , or a tumor. Since older women frequently develop compression fractures even without a fall, this can be important because we know then that the pain is likely severe, but time limited, and will resolve in a month or two. This makes it easier to treat with strong medication, like narcotics, because there is less concern for addiction. X-rays do not show discs, but disc herniation is much less common in older people so its of less concern.
Chiropractors focus entirely on spine pain and may be very helpful. Since many medical doctors are not very familiar with PD, I assume that many chiropractors probably arent either. Therefore it will be helpful to find one who is familiar with PD. Probably the best way to do this is through a Parkinsons Disease support group in your area.
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S Of The Body Affected By Dystonia
People with Parkinson’s can experience this disease-related cramping or clenching differently. Areas impacted include:
- Arms, hands, legs and feet: Involuntary movements, spasms or twisting and “curling”
- Neck: May twist uncomfortably, causing the head to be pulled down or to the side. This is called cervical dystonia or spasmodic torticollis
- Muscles around the eyes: May squeeze involuntarily, leading to a person to blink too much or to have difficulty opening the eyes also called blepharospasm.
- Vocal cords and swallowing muscles: May cause a person’s voice to sound softened, hoarse or breathy
- Jaw: May open or close forcefully or there may be grimacing of the face
- Abdominal wall: May cause sustained contractions, involuntary, writhing movements of the abdominal wall, or grimacing of the face
What Treatment Is Available
For treatment to be effective, it is essential to understand the trigger or cause of the dystonia. Certain medications may be effective for some people but not for others. Some work by interfering with neurotransmitters in the brain and disrupting the messages they send to muscles. Others work by relaxing the muscles to reduce shaking and improve muscle control.
Depending on the cause and severity of your dystonia, your doctor may suggest the following strategies:
Remember that not all of these strategies will work for everyone so it is important to communicate well with your doctor so that, together, you can find the best solution for you.
Keeping a diary: If the dystonia is levodopa-related, it is a good idea to keep a motor diary to record when dystonic spasms occur and how they relate to the timing of medications. This information can help your doctor adjust dosage and/or timings of medication to better manage your dystonia. For more information, see Keeping a diary.
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Nocturnal Leg Cramps Take Their Toll
Most nights I awake about 2 a.m. writhing in pain, drenched in sweat, and yelling for help. One of my legs is spasming out of control and the muscles feel hard to the touch. I try to move my leg, to forcefully extend it outside of the curled up ball that is now me, but it is too rigid to change position.
Tony, I cant move, I call to my husband, trying to tone down the panic Im feeling. Im paralyzed.
No, youre not, he responds as he sits down beside me on our bed, massages my limbs, and calmly reassures me that my cramping will relax in 10 minutes and we will go to the kitchen to have a snack, just like we always do. Thankfully, he is right.
The first I heard of nocturnal leg cramps was about two years ago when I started experiencing them myself. Gaining in frequency and intensity over time, the cramping has risen to the number 1 spot on my personal list of favorite PD symptoms, dropping incontinence to number 2. Imagine how painful leg cramps are that they beat out incontinence and the inconvenience and embarrassment that accompanies it.
- Narrowing of the arteries that deliver blood to the legs.
- Compression of the nerves in your spine.
- Too little potassium, calcium, and magnesium.
Muscle cramps and dystonia occur when muscles tighten or shorten involuntarily. Parkinsons muscle cramps are generally caused by muscular rigidity and reduced movement rather than by muscles contracting.