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cldm

Help with questionable diagnosis

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Hi

I am in my low 30's and have had one neurologist diagnose me with parkinsons and one saying I have parkinsonism signs but he is not 100% convinced it is PD. Even I don't think I fit the criteria good enough so I would be interested in hearing alternative ideas.

I have only two issues that have been taking me to the doctor the past 8 years, the first being a persistent tightness in my left shoulder which has been very slowly getting worse and affecting my neck and arm. The second neuro isn't 100% convinced this is related.  The second issue is the one that landed at me at the neurologist, and is the most bothersome, being legs that significantly tighten up when walking. It started out being intermittent and then progressed to happening full time over 2 years or so, and is now at the stage where I can only walk 20 or 30 steps before the cramp forces me to stop.  Around the same time my legs started having issues with tightness, I started having non-stop fasciculations everywhere (feet, legs, arms stomach, face etc).  The fasciculations don't particularly bother me, but the neurologist insisted on a nerve conduction study which were normal.

Muscle relaxers like Norgesic and Baclofen have made no difference (although the tend to help with sleeping), but completely to my surprise, pramixperole extended release gave me a full recovery after 6 hours of taking the first 0.75mg dose, and seems to work for about 28 hours. It made me feel slightly sick, and messed with my sleep after a few weeks, so the neurologist switched me to Azilect, which took about 3 days to start working, but also gives my leg issues a massive improvement. I have been on Azilect for 2 months and the leg issues are staying away, and don't seem to have any significant side effects.  I also tried a non-slow release pramixperole 0.25mg which kicks in much quicker, but only has an effect for 2 hours or less, and then my legs go completely back to being stiff again.

I understand these two tablets are aimed at parkinsons, but I feel like this is clouding the judgement of the neurologists.

My only parkinson like symptoms that the neurologists have pointed out are a left hand that doesn't do well in a finger tapping test, stiffness and response to these tablets. I don't have a tremor, normal MRI, normal nerve conduction study, previous B12 shots for slightly low B12 which has remained normal, and take ongoing low doses of thyroxine for mild hypothyroidism which has remained normal.

I'd really appreciate any feedback or alternative ideas to ask the neurologists about.

Thanks for your time.

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Thanks for the question.  Based on many of your symptoms this could definitely be PD and you may want to get a second opinion from another neurologist or a DAT scan.  If you get another opinion it may be useful to go to the appointment off dopamine medications overnight.  Hope that helps.  The description of fasciculations doesn't fit and maybe he/she can examine that and if these are not true electrophysiological fascics then it may all be PD. 

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Thanks very much for taking the time to reply - It is much appreciated.  I'll report back in time after I get another opinion off medication.

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