Dystonia In Parkinsons Disease
Dystonia refers to a condition in which the muscles repeatedly contract or twist involuntarily, leading to movement and postural abnormalities. Dystonia can affect a single muscle, a group of muscles, or the whole body. These symptoms can occur on their own or as a symptom of another disorder, such as Parkinsons disease. Dystonia does not always indicate a person has PD, and not every person with Parkinsons will experience dystonia.
When dystonia does occur in PD, it frequently affects the feet and toes. A significant portion of people with Parkinsons disease awake with painful cramping in one or both feet. Dystonic Parkinsons disease also can cause a rare condition called cervical dystonia . Cervical dystonia causes involuntary in the neck that cause painful misalignment of the spine. Fortunately, the vast majority of people with PD will not develop this type of dystonia.
Pain Is An Unfortunately Common Problem In Parkinsons Disease
Of course, pain is common in the general population, especially among older people. A recent American study found that pain affected about twice as many people with Parkinsons Disease than those of the same age and gender without PD. About 50% of Parkinsons Disease patients in that study suffered from painful disorders. Men and women seem to be about equally affected. A very well described scenario is the patient who is followed for a painful frozen shoulder for a year or so before a tremor develops leading to a diagnosis of PD. Pain clearly plays a major role in quality of life. Everyone with chronic pain enjoys life less, leading to a vicious cycle in which pain causes depression or isolation which in turn leads to more pain.
Parkinson patients suffer from the same pain problems that other people have, often amplified by the motor dysfunction, but they also have additional pain problems which are unique to PD.
One recent review classified the types of pain Parkinsons Disease patients have into: musculoskeletal, in which the pain results from problems with the muscles , bones or joints dystonic, which is due to abnormal muscle contractions caused by the Parkinsons Disease or the medications used to treat it radicular pain, which is feels like the pain caused by pinched nerves central pain, which is presumed due to abnormalities in the brain, and is a continuously present pain that cannot be explained otherwise and discomfort related to an unpleasant urge to move.
How To Cope With Dystonia
I have PD. First thing in the morning as I am getting out of bed, my left foot cramps severely and my toes curl downward, making it very painful to walk. I have found that it helps if I put my feet flat on the floor immediately after sitting up in bed. Also foot massages help. If I can force the cramped foot so it turns outward, my toes uncurl. nelleford
When my dads legs cramp, massage helps relieve them. You can usually feel where the spasms are. Rub your hands together to warm them up first. Start below where the spasm is and work up towards them. With your fingers and palms, give a deep massage where the cramp is. Give your loved one mustard or pickles to relieve the cramp. I know it is weird, but it works. To prevent them, exercise is best. Try to get them to walk every day, even if it is only half a block. This will also help prevent falls. A good multivitamin every day can be beneficial. Look for one with magnesium and potassium in it. These minerals helps to prevent cramping. My dad eats bananas almost every day for this reason. kathyt1
Calcium governs muscle contraction, and magnesium governs muscle relaxation. I take a magnesium supplement if Im having leg cramps. Perhaps have your loved ones levels evaluated with a simple blood test. Potassium can be dangerous if its too high or too low, and too low can often cause muscle cramps. sherry1anne
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The Gastrointestinal Tract And Parkinsons
As promised in a previous blog, I now return to the topic of the gastrointestinal tract and Parkinsons disease . As most of you know, GI symptoms are very common in PD. We will discuss what those symptoms are, why they occur, and the current research that links what is happening in the gut to theories as to why PD occurs at all. Many of you have suggested gut-related topics for this blog including a discussion of symptoms such as bloating and constipation, and a discussion of the use of probiotics in PD. I will address these issues as well. Submit additional topics that you would like to read about here.
GI symptoms can be among the most bothersome of the non-motor symptoms of PD. Constipation is the most common of these symptoms, affecting 80-90% of people with PD. APDA has a helpful brochure with practical tips to prevent and treat constipation in PD.
GI pathology in Parkinsons disease however, can involve the entire GI tract and includes sialorrhea and dysphagia . In addition, delayed gastric emptying, in which the digestive contents are held up in the stomach and do not move normally into the small intestine, can cause sensations of nausea and bloating.
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How To Deal With The 6 Common Causes Of Leg Pain In Pd
Severe leg pain is a common complaint from people with PD. Lately, it is understood that central pain is common to Parkinsons disease, and can even be the first sign of PD, usually bilaterally. This blog post lists six causes of lower limb pain, and the importance of treating it. Treatments depend on properly identifying the source of pain. Some treatment suggestions are included.
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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.
What Medications Are Used To Treat Parkinsons Disease
Medications are the main treatment method for patients with Parkinsons disease. Your doctor will work closely with you to develop a treatment plan best suited for you based on the severity of your disease at the time of diagnosis, side effects of the drug class and success or failure of symptom control of the medications you try.
Medications combat Parkinsons disease by:
- Helping nerve cells in the brain make dopamine.
- Mimicking the effects of dopamine in the brain.
- Blocking an enzyme that breaks down dopamine in the brain.
- Reducing some specific symptoms of Parkinsons disease.
Levodopa: Levodopa is a main treatment for the slowness of movement, tremor, and stiffness symptoms of Parkinsons disease. Nerve cells use levodopa to make dopamine, which replenishes the low amount found in the brain of persons with Parkinsons disease. Levodopa is usually taken with carbidopa to allow more levodopa to reach the brain and to prevent or reduce the nausea and vomiting, low blood pressure and other side effects of levodopa. Sinemet® is available in an immediate release formula and a long-acting, controlled release formula. Rytary® is a newer version of levodopa/carbidopa that is a longer-acting capsule. The newest addition is Inbrija®, which is inhaled levodopa. It is used by people already taking regular carbidopa/levodopa for when they have off episodes .
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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.
Causes Of Leg Cramps In Seniors
Aging causes a natural shortening of tendons and result in leg muscle cramps. It is estimated that about 75% of leg cramps occur at bedtime or during the night and can disturb the sleep pattern.
Statistics indicate that most adults above the age of 50 will experience leg cramps at least once while adults over 60 years of age are 33% more likely to have a leg cramp at night at least once every two months . Night leg cramps in seniors are not uncommon.
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Low Levels Of Potassium
Potassium is an electrolyte that helps control muscle cell and nerve functioning. Having low potassium can cause muscle cramping, particularly in your feet and legs.
Chronic low potassium, or hypokalemia, can cause cramping in your muscles. Hypokalemia doesnt always cause symptoms when its mild. When it becomes severe, it can cause:
- fatigue
- weakness
- abnormal heartbeat
To diagnose hypokalemia, your doctor will measure potassium levels in your blood and urine. Sometimes, low levels of calcium and magnesium can also cause muscle cramping.
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Is leg pain a symptom of Parkinson’s?
Wednesday September 25, 2013
Leg pain can be significant and have many causes some related to Parkinson’s disease, some that increase in frequency with age and others that are more common in both conditions. Here are just a few:
Pain associated with Parkinson’s
- Off related pain – diffuse aching and/or throbbing pain that increases at end of dopaminergic medicine dosing or when medication levels are low. Unlike joint pain, this pain is often located in the muscle such as the thigh or calf but not the knee of ankle. PD medications can often improve this pain.
- Restless leg syndrome – uncomfortable sensations most commonly felt in legs that is worse at night and while resting and relieved with movement. See related post on restless leg syndrome for more information.
- Dystonia-involuntary contraction of muscle. This can be common as a symptom of PD, an off related symptom or as a form of dyskinesia from medication. An example is early morning foot dystonia described as painful cramping of the toes and feet. Botulinum toxin therapy can help
Musculoskeletal
Neuropathic
General Pain
- Leg swelling can occur with PD, medications and other medical conditions. Abrupt change in leg swelling associated with pain could be a sign of a blood clot requiring immediate medical attention. Lack of movement and dehydration can increase this risk in PD.
Monique L. Giroux, MD
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Treatment Depends On Properly Identifying The Type
If pain is bilateral always assume it is central pain pain due to PD. In my experience Azilect works great for this type of pain. Other medications which can be employed for this pain as well.
Massage therapy works for all types of leg pain-my favorite therapy but can be costly. Water therapy may also work for all types except central pain. Physical therapy can alleviate dystonia pain, as well as musculoskeletal and radicular pain.
If pain is due to dystonia related to levodopa intake, find out when it occurs—end of dose or at peak dose. Typically adjusting medication doses will resolve problem. However, if dystonia is an initial symptom of PD, initiating treatment with levodopa will resolve. If medication adjustment does not work well for levodopa induced dystonia, another treatment option is DBS . Pain due to dystonia independent of cause can also respond well to Botox injections, as well as centrally acting muscle relaxants. To avoid and alleviate pain caused by stiff muscles, a great treatment option is activity in the form of stretching exercises—any number of activities will do such as tai-chi or yoga. For me when I start having radicular pain shooting down my leg it is time to up my levodopa dosage.
If you are having leg pain make sure to discuss it with your physician.
Physical And Occupational Therapy
It may be difficult to exercise when you are in pain. However, if you are in pain while moving and suddenly stop, the pain can get worse. A physical or occupational therapist can recommend exercises or techniques to target the source of your pain and to stretch and strengthen the body parts most affected by dystonia.
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Additional Ways To Stop Foot Cramping
Aside from the strategies mentioned with each cause of foot cramping above, there are several other things you can do for foot cramps. Massaging your feet, especially in the middle of a cramp, can help. If you are in pain, try taking an over-the-counter pain reliever. Cool or hot compresses can also relieve muscle pain.
In a recent study at Brigham Young University, researchers found that pickle juice was effective at stopping exercise-induced cramps once they started.20Scientists arent sure why this worked, but they think it may have something to do with muscle fatigue.
What Are The Different Stages Of Parkinsons Disease
Each person with Parkinsons disease experiences symptoms in in their own unique way. Not everyone experiences all symptoms of Parkinsons disease. You may not experience symptoms in the same order as others. Some people may have mild symptoms others may have intense symptoms. How quickly symptoms worsen also varies from individual to individual and is difficult to impossible to predict at the outset.
In general, the disease progresses from early stage to mid-stage to mid-late-stage to advanced stage. This is what typically occurs during each of these stages:
Early stage
Early symptoms of Parkinsons disease are usually mild and typically occur slowly and do not interfere with daily activities. Sometimes early symptoms are not easy to detect or you may think early symptoms are simply normal signs of aging. You may have fatigue or a general sense of uneasiness. You may feel a slight tremor or have difficulty standing.
Often, a family member or friend notices some of the subtle signs before you do. They may notice things like body stiffness or lack of normal movement slow or small handwriting, lack of expression in your face, or difficulty getting out of a chair.
Mid stage
Mid-late stage
Standing and walking are becoming more difficult and may require assistance with a walker. You may need full time help to continue to live at home.
Advanced stage
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Second Type Of Leg Pain Is Caused By Dystonia
When related to levodopa, it usually occurs as a wearing off but can also occur at peak dose. In most cases this leg pain is unilateral and has direct correlation to medication intake. When pain is due to dystonia, it is more common in early morning. This type of leg pain is usually accompanied by toes curling and foot abnormally posturing.
Opening The Medicine Box In The Mind: The Psychology Of Pain
In this 50-minute lecture, Beth Darnall, PhD explains how our experience of pain goes beyond the physical sensation of pain. It has emotional and psychological components that affect our ability to treat pain. She cites research to demonstrate that and shares 13 specific tips to reduce the experience of pain and increase treatment effectiveness. Audience questions follow the lecture.
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When To Call Your Doctor
You should contact your doctor if your foot and leg cramps are severe and occur frequently.21Other reasons for calling your doctor about muscle cramping include muscle weakness and atrophy and the inability to sleep because of nighttime cramps. Alcoholics who experience foot and leg cramping should seek medical care.
Although foot cramping can be a briefly painful annoyance, it is usually not serious. Take good care of your body, and you will experience less incidence of foot cramps.
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.
Physical Therapy
Alternative treatments
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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