Dystonia Or Muscle Cramps
Muscle cramps and dystonia occur when one of your muscles, or a group of muscles, tightens or shortens involuntarily.
Muscle cramps and dystonia can be confusing as they can feel very similar. You may not always be able to tell the difference between them, but they are caused by separate problems and are therefore treated differently.
Muscle cramps in Parkinsons are generally caused by muscular rigidity and reduced movement rather than by muscles contracting. But, like dystonia, cramps can also be painful and very distressing.
Normal painkillers do not usually relieve them, but cramps often respond well to massage and the use of a hot water bottle or heated pad. Movement and exercise may also help to release cramps and reduce stiffness. If these do not help, then your doctor may prescribe muscle relaxants.
Body Parts That Can Be Affected With Dystonia In Parkinsons
Repetitive and sustained eye closure is known as blepharospasm. To the observer, this looks like increased blinking, which may increase in certain situations such as in bright light. The frequent blinking/eye closures can interfere with activities such as reading or driving. This can be associated with PD, but may also accompany other forms of parkinsonism such as Progressive Supranuclear Palsy. The most common treatment for this disorder is Botulinum toxin injections.
In PD, the trunk can tilt to one side or flex forward. Forward flexion of the trunk is known as camptocormia. Similar to neck flexion, it is unclear whether the flexion is due to dystonia causing overactivity of muscles that pull the trunk down, or weakness of the muscles that keep the trunk upright. Typically, although the forward flexion may appear very profound when upright, the patient can lie flat in a bed or sometimes even straighten up against a wall, demonstrating that the flexion is not due to a permanent deformation. Treatment options are similar to those available for neck flexion. Spinal surgeries which attempt to straighten the torso have been reported in a handful of patients. Results were mixed including a very high rate of surgical complications. These surgeries are generally not performed.
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Is Parkinsons Disease Inherited
Scientists have discovered gene mutations that are associated with Parkinsons disease.
There is some belief that some cases of early-onset Parkinsons disease disease starting before age 50 may be inherited. Scientists identified a gene mutation in people with Parkinsons disease whose brains contain Lewy bodies, which are clumps of the protein alpha-synuclein. Scientists are trying to understand the function of this protein and its relationship to genetic mutations that are sometimes seen in Parkinsons disease and in people with a type of dementia called Lewy body dementia.
Several other gene mutations have been found to play a role in Parkinsons disease. Mutations in these genes cause abnormal cell functioning, which affects the nerve cells ability to release dopamine and causes nerve cell death. Researchers are still trying to discover what causes these genes to mutate in order to understand how gene mutations influence the development of Parkinsons disease.
Scientists think that about 10% to 15% of persons with Parkinsons disease may have a genetic mutation that predisposes them to development of the disease. There are also environmental factors involved that are not fully understood.
Stages Of Parkinsons Symptoms
Parkinsons symptoms can be divided into three categories or phases: pre-motor, motor, and cognitive. These phases dont necessarily happen in chronological order, and not all Parkinsons patients will experience all symptoms.
The premotor phase is the phase of Parkinsons in which non-motor symptoms are present. These symptoms include:
- loss of smell
There are two main categories of tremor: resting tremor, and action tremor. Resting tremor occurs when muscles are relaxed, like when your hands are sitting in your lap, and lessen during sleep or when the body part is in use. Action tremors occur with the voluntary movements of a muscle.
Tremors typically affect only one side of the body but may affect both sides as the disease progresses. Fatigue, stress, and intense emotion may worsen tremors.
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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.
The Two Most Common Pd Drugs
Michael J. Fox Foundations Rachel Dolhun, MD, dicusses the 2 newest versions of levadopa and another in the pipeline
Dopamine replacement : The main drug used to treat PD symptoms, levodopa is chemically very similar to the bodys natural neurotransmitter. The drug, which is taken by mouth, enables the brains basal ganglia to convert levodopa to dopamine meaning levodopa acts like dopamine in the brains movement centers. Levodopa can produce dramatic results, especially in reducing rigidity and tremors and improving movement. Its generally taken in combination with carbidopa, which keeps the levodopa from being broken down in the digestive tract before it reaches the brain. It also permits a lower dose of levodopa and reduces side effects, which can include nausea and facial flushing . Two new extended-release carbidopa-levodopa drugs were just approved this year: Duopa, an oral medication approved for some patients in the later stages of Parkinsons, and Rytary. In a clinical trial, users of Rytary reported that their amount of off time improved by more than an hour a day.
Howard Weiss, MD, director of the Parkinsons Disease and Movement Disorder Programs at the LifeBridge Health Brain & Spine Institute in Baltimore, says the approach of delaying levodopa was fueled by a phobia, a scare that started more than 2 decades ago, based on the belief that levodopa accelerated disease progression.
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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.
What Is Special About Parkinsons Syndrome Sufferers
Parkinsons Syndrome is a condition where the important nuclei below the brain become dysfunctional resulting in impaired communication and transmission of nerve impulses to and from nerve fibres throughout the body. Consequently some cognitive processes, eyesight focus, muscle control or strength may deteriorate. This often presents in a haphazard fashion with increasing stiffness of the joints and muscles and intention tremor most noticeable in the hands. Fine movements and writing ability deteriorate, The gait deteriorates as seem as a shuffling pattern with small steps with a quickening of gait as power is mustered and spasm is overcome, Whilst there is a downhill trend the process of deterioration may arrest for periods.
Seldom does this process directly generate nerve pain such as sciatica. Back or Neck pain and pain referred in to the arm or leg may arise in Parkinsons Syndrome Sufferers as part of the Degenerative Disc Disease seen in the rest of the population and with the same pathologies disc protrusions, nerve entrapment / scarring / tethering, Lateral Recess Stenosis, Axial Stenosis, Spondylolytic Spondylolisthesis, vertebral slippage, Instability, Failed Back Surgery or failed chronic pain management.
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What Is Smooth Muscle
Smooth muscle is located in the walls of hollow internal structures in the body, like the arteries, intestines, bladder, and iris of the eye. They tend to circle the structure and when they contract, the hollow structure is squeezed. These muscles are involuntary and are controlled by the unconscious part of our brain function using the autonomic nervous system. The autonomic nervous system always runs in the background, regulating processes within the body. There is a balance between the sympathetic system that speeds things up and the parasympathetic system that slows things down. These names are based on the type of chemical that is used to transmit signals at the nerve endings. Adrenaline allows the body to respond to stress. Imagine seeing a bear in the woods your heart beats faster, your palms get sweaty, your eyes dilate, your hair stands on end, and your bowels move, all because the sympathetic nervous system is activated. Acetylcholine is the chemical that is anti-adrenaline and is involved in the parasympathetic nervous system that acts to calm us down. Smooth muscle has the same basic contraction mechanism as skeletal muscle, though different proteins are involved.
How Might Dystonia Be Experienced
- Feet: people with Parkinsons mainly experience dystonia in their feet. Typically the toes curl up into a claw-like position, the foot turns inwards at the ankle, and occasionally the big toe sticks up. This position, caused by spasms in the calf muscles, can be very uncomfortable and makes it hard to fit feet into tight shoes.
- Hands: writers cramp in the hands only occurs during handwriting.
- Neck: cervical dystonia affects the neck muscles, which causes the head to twist to one side, forwards or occasionally backwards.
- Eyelids: the eyelid muscles may contract and make the eye close involuntarily . This is often experienced as excessive blinking, intolerance to light, a burning feeling in the eye or irritation.
- Vocal cords: dystonia affecting the vocal cords or speech muscles makes speaking difficult or strained.
- Jaw area and side of the face:oromandibular dystonia affects the jaw area, tongue, mouth or one side of the face. The jaw may be pulled either open or shut, and speech and swallowing can be difficult.
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The Preponderance Of Injury In The Past Of People With Pd
Neck issues or damage can be caused by injuries, but the injury site doesnt have to be local to the neck itself, since it is an integral part of the kinetic chain of the human body – problems anywhere else which affect posture can, in turn, profoundly affect how we tense our necks and cause strains on it by the way we are holding up the head. Ive frequently asked people with Parkinsons Disease to think carefully about any pains and injuries which they might have incurred either before or concurrent with their PD diagnosis. Ive found that the overwhelming majority of us have suffered a prior accident or physical trauma. Injuries to jaw, neck, shoulders, back, hips, knees or feet predominate. All these severely affect posture and hence the kinetic chain and are liable to make our necks prone to permanent strains and stiffness. So in my view, even if chemical cures were invented tomorrow, people with PD would still present with the postural problems, still suffer from the old injuries which have been masked by the narratives of neurology, and would probably quickly decline into pain and problems again, unless these past injuries are properly attended to.
Who Is Affected By Dystonia
Dystonia is generally uncommon, although it’s one of the more common neurological conditions.
Dystonia can affect men, women and children. It can be difficult to diagnose, and there may be many people with the condition who remain undiagnosed.
The Dystonia Society estimates that at least 70,000 people are affected by dystonia in the UK. At least 8,000 of these are children and young people.
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Leg Pain And Parkinson’s
Interestingly enough, one of my early symptoms of the disease was deep searing pain in my left leg, the type of pain my grandma had complained about many times. Initially this type of pain was worst in the morning as well as at night, making me think is was some sort of fasciitis. However not only did typical anti-inflammatories and muscle relaxants not alleviate my pain but pain worsened over time to a constant burning pain that felt as if someone was tearing the muscle and pouring hot oil on it. The pain was so excruciating it was permeating into all aspects of my life. I was constantly in need of deep tissue massage asking my husband to massage my legs just as my grandmother had asked of us time and time again. This helped only temporarily.
Which brings me to the four types of leg pain in PD.
Treating Dystonia In Parkinsons
Treatment options for dystonia include:
- Dopaminergic medication adjustment as discussed above
- Botulinum toxin injections of the affected muscles
- Physical therapy to loosen and strengthen the dystonic body part
- Trying other medications that target the dystonia directly such as muscle relaxants or anti-cholinergic medications
- Use of a device to provide a sensory trick*.
- Deep brain stimulation can be considered in difficult-to-treat situations
*To minimize their dystonia, some people have success using an interesting tactic called a sensory trick. A sensory trick is defined as a physical gesture that mitigates the production of the dystonia. For example, touching the eyebrow may help keep the eyes open, or touching the chin may keep the neck from twisting. In my clinical practice, one woman wears metals rings on her dystonic fingers to help them assume a more normal position. Another man wears 5-toed shoes to prevent dystonic toe curling
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What Causes Pain In Cases Of Parkinsons Syndrome Sufferers
Parkinsons Syndrome Sufferers may present with various combinations of back, buttock and leg pain, numbness and muscle weakness, Symptoms are often aggravated by an abnormal asymmetrical gait arising from loss of spatial awareness muscle spasm and loss of limb control. The back pain may arise from irritation within the disc wall but more commonly arises from the pinching of the trapped nerve in the exit doorway from the spinal column. The foramen may be distorted and the nerve is tethered by years of scarring reaction to repetitive bruising, can not evade the pinching by the bulging distorted disc wall or overriding facet joints . The disc may be degenerate and bulging and contribute to the irritation of the tethered nerve. When advanced the compression causes numbness and weakness to develop. The patchy weakness or spasm of the muscles controlling the spinal segments results in asymmetrical loss of control or stiffness of the disc levels and aggravation of the effects of the local pathology at each level and aggravation of symptoms arising at these levels.
How Are Spasms Treated
Initial treatment is typically conservative but depends on the cause of the spasms and the severity and duration of the symptoms.
New Health Advisor says rest, ice, moist heat, gentle stretching and non-steroidal anti-inflammatory medications, like ibuprofen, are common recommendations in cases of acute injury.
Elastic binders are available over-the-counter and when worn around the ribs, act as pain-reducing splints.
If the cause of spasms is related to broader issues such as genetics, body weight and deconditioning, interventions to address the root causes, as well as pain relief are important.
Unless there is a correctable, underlying issue, there are no surgical treatment options.
For cases that dont respond to early conservative treatment, doctors often recommend physical therapy according to Livestrong.com.
A skilled therapist can not only assist with pain management, but she or he can also help patients gain flexibility, strengthen muscles that support the intercostals and design a home exercise plan to maintain long-term recovery.
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The Link Between Methamphetamine Addiction And Parkinsons Disease
Recent studies have linked the use of methamphetamine and amphetamine drugs, some of the most commonly used substances, to an increased risk of Parkinsons Disease. The adverse effects of methamphetamine on the neurotransmitter dopamine relate directly to a dopamine deficiency strongly associated with Parkinsons.
When other factors were also examined, including factors known to contribute to higher rates of Parkinsons, prior use or use of methamphetamines most strongly correlated with a significant increase in the risk of developing the disease.
Parkinsons is a degenerative central nervous system disease that affects approximately one million people in the United States. It is characterized by muscle tremors and spasms, muscle rigidity, impaired coordination, and decreased mobility.
How Is Parkinsons Disease Diagnosed
Diagnosing Parkinsons disease is sometimes difficult, since early symptoms can mimic other disorders and there are no specific blood or other laboratory tests to diagnose the disease. Imaging tests, such as CT or MRI scans, may be used to rule out other disorders that cause similar symptoms.
To diagnose Parkinsons disease, you will be asked about your medical history and family history of neurologic disorders as well as your current symptoms, medications and possible exposure to toxins. Your doctor will look for signs of tremor and muscle rigidity, watch you walk, check your posture and coordination and look for slowness of movement.
If you think you may have Parkinsons disease, you should probably see a neurologist, preferably a movement disorders-trained neurologist. The treatment decisions made early in the illness can affect the long-term success of the treatment.
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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.