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New normal

Extremely painful dystonia management

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New normal    1,273

Dr Okun:

I am 70 yo woman. Obvious PD symptoms since 2008, dx'd PD 2011.   4 negative DaT scans.    Several atypical  autonomic functions including hypostatic B/P (tilt table),  radical changing BP day and night, severe sleep disorder, RLS, halting speech, bladder/bowel dysfunction. 

Neuro dx "atypical Parkinsonism" and observing for  MSA.  I take  375/1500 C/L daily.     I recently have excrutiating pain/ and severe muscle cramping in right groin, upper thigh, and calf.  Have had xray, CT scan, ultra sound, steroid injections. Neuro prescribed gabapentin 300 mg 2 to 3 x daily.  Which immediatley stopped pain  However, in a few weeks I have increased doseage to manage pain.  

In last few days, I have had periodic cramping in right bicep where a portion of the muscle(or tendon) rises approx 2 inches. It also responds to gabapentin.  Extremely painful.  So I am accepting I must be experiencing dystonia. Ive read as PD increases, C/L loses effectiveness, and dystonia may increase.

i know you can not dx w/o seeing me.  In your opinion is this likely dystonia?  Is this scenario consistent with rapid progression seen in MSA? How is this extreme disabling/painful symptom managed?   

NN

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Dr. Okun    409

This type of painful symptom you respond is not commonly observed with PD.

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