worried nurse/medical student

[MG (Admin)]

today... i realised that staying in a certain position can increase my feeling or cause a change of side.

This is a good sign that it has nothing to do with a physical disturbance in the nervous system.
Symptoms of MS do not vary in the way you describe.
As long as there is no change in your function you can relax
all the best

[dorado]

what about the 0.3T machine accuracy? is it at all useful for my situation?

[MG (Admin)]

No. In your case there is certainly no need as your neurological exam (according to your previous emails) showed no signs suggestive of MS.

[dorado]

hmm... maybe i didn't express myself clearly... when i did my MRI I was under the impression that the machine they used was a 1.5T open machine. i figured out yesterday that it was a 0.3T open machine whis is a lot lower than the minimum 1T recommendation from Mcdonald. thats why I asked you do you think the MRI I had is at all useful for my situation or I do have to get another one?

ps: if you did understand me correctly the first time, i apologise for the repeat.

[MG (Admin)]

I did understand first time
In some situations it is important i.e. when there are clear abnormalities on exam (not true with you) or if the history is suggestive of MS (yours is not) or if the lower res scan showed some kind of abnormality (yours did not).

All the best

[dorado]

hi!!

i came across two articles concerning my PKD and I wanted to know if you agreed with my conclusions:

Clinical evaluation of idiopathic paroxysmal kinesigenic dyskinesia
New diagnostic criteria
M. K. Bruno, MD, M. Hallett, MD, K. Gwinn-Hardy, MD, B. Sorensen, BA, E. Considine, BSN, S. Tucker, MD, D. R. Lynch, MD, PhD, K. D. Mathews, MD, K. J. Swoboda, MD, J. Harris, PhD, B.-W. Soong, MD, PhD, T. Ashizawa, MD, J. Jankovic, MD, D. Renner, MD, Y.-H. Fu, PhD and L. J. Ptacek, MD


Based on our results, the clinical criteria we propose are as follows:
Identified kinesigenic trigger for the attacks (ok)
Short duration of attacks (<1 minute) (ok)
No loss of consciousness or pain during attacks (ok)
Exclusion of other organic diseases and normal neurologic examination (theorically ok , MRI negative, no signs on neuro exam)
Control of attacks with phenytoin or carbamazepine, if tried (not tried)
Age at onset between 1 and 20 years, if no family history of PKD (ok)

so in theory i fit these criterias, But Dr JAncovic adds

Secondary paroxysmal dyskinesias Jaishri Blakeley, MD, Joseph Jankovic, MD * Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas, USA

Multiple Sclerosis
Although we had only one patient with PxD secondary to MS, it is the most frequently cited cause of secondary PxD in the literature.[18-21] PxDs in MS are described as painful isometric muscle contraction(tonic spasms), often preceded by an aura and precipitated by voluntary movement or sensory stimulation, lasting seconds to minutes and occurring many times per day.[18-21] Although lesions to the spinal cord are most commonly cited,[21] PxD in MS has been associated with lesions throughout the CNS.[22] The pathophysiological mechanism of PxD in MS is unknown; however, it has been proposed that it is related to ephaptic transmission.[19


so no1: i fit the PKD criteria
no2: i dont fit the painful criteria of MS

weirdly bruno & al (2004) dont consider as idiopathic PKD a painful spasm

based on these two articles i should be reassured right.... Jankovic (2002) really is saying that PKD inMS is painful??


thank you in advance

[MG (Admin)]

Yes, I agree with your conclusions which indeed point to the fact that MS is not suspected in your case.

All the best

[dorado]

ok but.... i havnt had any spasm for the last 2 months, my symptoms are mainly sensory(see first post). and for the last 5 days its really the heat-cold sensation on my skin thats been bugging me, the alternating side weird feeling is also still there. I am planning to go see a MS specialist in the states in 2 weeks. Waste of money or wort it? If you think i should insist more on psychiatry you can say too . i just want to be sure its not MS.

[MG (Admin)]

On the basis of what you have told me so far you do not have MS.
If you want to get reassured by an expert that you do not have MS then an MS expert would be the right choice.
Once they reassure you (as I believe they will ) then you should definitely see the psychiatrist.

Let us know how it goes.

All the best

[dorado]

hi!

so I saw an MS specialist and was able to speak with a movment specialist for about an hour

1- the MS specialist thinks the feelings I have are related to the PKD. my MRI isnt the clearest but sufficient to say tht i dont have MS considering the physical exam is totally normal. final impression: PKD with superimposed anxiety

2- the movement specialist believes that because all my neuro exams are normal and my MRI is negative, MS is ruled out. How ever he does not believe that the constant changing side feeling i feel is reated to PKD. final impression: anxiety

so as you can see they cant agree on my weird feelings. what should I do next.

PS: psychiatrist wants to wait before starting me on a SSRI

[MG (Admin)]

Well they both agree you don't have MS and that you do have anxiety. The only thing they don't agree on is whether PKD explains your symptoms...in this case the movement disorder expert is in the best position to know as MS specialists in general don't treat much PKD.
I think that you really do need to deal with your anxiety somehow so I would go back to the psychiatrist to discuss this.

all the best

[dorado]

can wilson explain my symptoms... neurologist suspects presents of Feisher rings in my eyes. i will se the ophtalmologist soon.

[MG (Admin)]

Please see my first response to your first email:-

Re: worried nurse/medical student

Postby MG (Admin) on 16 Jun 2009 03:11 pm
Thanks Dominic,

Well I will allow myself to be more technical than usual given your background.

It sounds likely that you have a movement disorder which may actually be a type of dystonia. I cannot commit to this without seeing you but it may be worth seeing a movement disorder specialist for this.
In terms of investigation, we always exclude Wilson's disease (by checking liver function, the eyes and ceruloplasmin levels) and also (if dystonia is a possibility) then we always try L-dopa containing meds given the possibility of dopa-responsive dystonia.

MS can cause tonic spasms but this is a rare presentation. In fact dystonia is a grey matter problem whereas MS is a white matter problem.
In other words MS is a remote but highly unlikely possibility
It is clear that you do need an MRI as your symptoms are more on one side than the other and therefore a structural lesion must be excluded...in all likelihood nothing of any worry will be found but it is important to do in any case.
Bottom line:- you should get seen by a movement disorder specialist
Hope that helps...
let us know how it goes

[dorado]

I saw the ophtalmologist no ring was found.... so i'm back to uncertainty, although i'm glad to not have Wilsons. My mental health is really starting to be impacted. i'm overly sensitive, lethargic, loss 30 pounds in 5 months b/c of no appetite from the stress. I have begun effexor but i'm not sure its right for me as I am even more distressed. My symptoms (hyperexcitability +
muscle tension at shoulder and above knee weakness ???) are still there and changing sides. I have done all i could and feel trap right now any advice could help. thank you


anxious and depressed Dom