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Questions posted in the
Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.
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Subject: Re: Questionable - Myasthenia Gravis Six months ago I was affected with uncontrollable muscle movements affecting my head, neck, and right arm. It was thought that I was having seizure activity from an allergic reaction to the antibiotic: Flagyl. I was taking Flagyl for a chronic dental abscess that spred to the sinus area. I was hospitalized for this activity. The physicians were unable to give me a neurological diagnosis. Therefore giving me a psychological one. I have seen a few neurologist who have said that the movements are a form of dystonia, but are unable to say the exact form of the dystonic movements. Over the months I have gathered a few more systoms. I now have weakness/fatigue that varies throughout the day. Any sustained/repetative activity causes even greater weakness. Enabling me to even be able to pick up a glass of water. ( for example. ) After a rest, the strength returns, but has never returned to it's original state. I also have visual disturbances such as excessive floaters, lightning like floaters, double vision, and a loss of some of my visual field. I have seen several Opthamologist's who have said that this is not from a detached retina. My eyelids flutter when they are closed and sometimes I have difficulty swallowing or talking. I have seen different physicians who have said that my problem is of neurological nature, but I have also seen a few who have said they do not know what I have. Therefore since they don't know, they said it was probably of psychological nature. I am currently waiting to see a weel known university neurologist who can hopefully help with this problem. I had never had neurological problems before my dental abscess and can't seem to get rid of them now. I was placed on Amitriptylin 50 mg and it has stopped the dytonia for now. I am not looking for a diagnosis, but I would like to know if anyone has had this problem? Can anyone help?? THANK YOU !! = At first inspection, I doubt that this is myasthenia gravis. Myasthenia is strictly a syndrome of the peripheral nervous system (specifically, disturbance of transmission of signals at the neuro-muscular junction). Therefore, the visual disturbance and adventitious movements don't fit. The fatiguability is, of course, seen in myasthenic syndromes, but given the other symptoms I'd say there is another explanation. I think you are wise to seek an academic neurologist. The "seizure" episodes are curious and bear investigation. A careful physician will get a detailed description of these events. Do the best you can in describing: onset, sequence, duration, frequency of occurrence, triggering factors, etc. If other people have witnessed the events, maybe someone (spouse, etc) should come along with you to talk with the doctor. The suspicion of dystonia is interesting. Dystonic syndromes can certainly be puzzling, and you may be referred to a subspecialist in movement disorders to sort it out. Dystonia can affect many parts of the body and has many potential causes (hereditary, drug reactions, post-traumatic, and the old standby "we don't know"). It's worth investigation. Good luck. I hope this little bit helps. CCF MD mdf.
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