How Can I Treat Episodes Of Dystonia
You first need to determine the cause of your muscle pain and make sure it is not cramps.Secondly, you must determine when dystonia occurs in regard to your levodopa dose intakes. The best way to do this is by keeping a diary for a few days. You will then be able to explain this phenomenon in full detail to your neurologist, who will be able to optimize your treatment with you.
Many people with episodes of dystonia reduce the intensity of their pain by:
- Gently touching the affected body part with their finger or with other objects of different textures
- Touching a part of the body close to the part affected by the contraction
- Stretching the part of the body affected by the contraction
Relaxation techniques can also help relax muscles affected by dystonia.
Leg Pain And Parkinsons
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.
Pain In Parkinsons Disease: A Spotlight On Women
This 2-page interview with neurologist, Dr. Jori E. Fleisher, discusses pain in Parkinsons disease with some interesting statistics about women and pain. Dr. Fleisher outlines the 4 primary types of pain in PD, how depression interferes with pain management, the role of exercise and medications in pain management as well as alternative therapies.
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How Can I Help Myself
You will need to try a variety of sensory tricks to see what works for you as dystonia affects everyone differently.
Spasms may be reduced by touching the affected part of the body either before or during any movement known to trigger dystonia. Although this may not prevent or stop a spasm, touching can distract or trick the brain and reduce the length and intensity of a muscle contraction.
Simple massage exerting pressure on the foot, or the use of a hot water bottle or heated pad can also help, as can movement and exercise – see Coping Strategies – Tips & Tricks.
For eye spasms, some people find lying down, singing, yawning, laughing, chewing, putting pressure on the eyebrows or just talking can help. Spasms in the vocal cords may respond to yawning or sneezing.
Simply relaxing may also help so try taking a bath, having a massage or a calming activity such as yoga.
Content last reviewed: June 2018
Who Is Affected By Dystonia
Dystonia is generally uncommon, although its 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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How Are Parkinsons Tremors Treated
Tremor can be unpredictable. Some experts say itâs the toughest symptom to treat with medication. Your doctor may prescribe medication for your tremors:
- Levodopa/carbidopa combination medicines . This treatment is a type of medication called a dopamine agonist. Itâs usually the first treatment for Parkinsonâs.
- Propranolol . This drug is also used to treat high blood pressure, heart disease, and migraine.
- Clozapine . This medication is also used to treat schizophrenia. It requires weekly blood tests for the first 6 months.
Those taking levodopa/carbidopa may occasionally experience OFF periods in which their symptoms return. There are treatment options during these periods including a powder form of levopoda which can be inhaled or the medications istradefylline or safinamide .
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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Fourth Type Of Leg Pain Is Radicular Pain
In this case, the pain is caused by compression of nerves in lumbar area which results in weakness, numbness and tingling, and loss of reflexes from buttocks to foot in a distribution of a nerve. It can be acute or chronic, and can be worse with standing and sitting, or better with laying down. Of note: in my experience many patients including myself have these symptoms not because of physically herniated disc but rather by the stretching of a nerve in the canal as it exists due to severe musculoskeletal rigidity and abnormal posturing.
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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.
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.
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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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What Does Dystonia Feel Like
For some people, dystonia feels like a Charlie horse, which can be so painful that it wakes you up at night. For some, it feels like opposing muscles, muscles that work in pairs, are competing with each other. For example, when your bicep muscle contracts, your tricep muscle relaxes or elongates. In dystonia, both muscles want to contract at the same time, and it feels like theyre fighting. For some people living with Parkinsons, dystonia is the most distressing symptom they experience.
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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.
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
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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.
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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.
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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