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Neurology (Expert Forum)
Questions about dopamine and dystonia
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Questions about dopamine and dystonia
by newbith, Dec 20, 2006 12:00AM
31 year old wondering if this is descriptive of some sort of dystonia, possibly a dopamine-responsive one:
1. Foot problems. Born with them. When learning how to walk, dragged one foot all the time. Have had flat feet, much pain, and spasms ever since. Spasms can pull the toes into weird positions. Can pull big toe outward. Little toes curl downward. Spasms happen only on action. Always walk on outside edges of feet now. Can put them flat, but hurts like you wouldn't believe.
2. Pulse doesn't speed up enough when initiating exercise or when changing elevation. Have had many instances of passing out.
3. Exercise intolerance. Causes exhaustion, increased muscle spasms.
4. Muscle spasms happen anywhere in body now (recent change). Worse when sick, using certain drugs, or cold/hot.
5. History of depression.
6. Twitches, both skin and joint moving kind. Joint moving occurs in hands, feet, shoulders. Fingers accidentally tap buttons when resting over a mouse or keyboard. Twitches stop on voluntary movement.
7. Slight trembling on occasion. Feel it more than see it.
8. 12ish year old rash. Constant yeast infection. (please god someone explain that one) No history of diabetes. Have seen many docs about it but still have it.
9. Speech problems. Forget syllables, slur, rush words, mumble. Seems slowly progressive.
Strong history of familial tremor, just to add a dash of spice.
Main doc getting me an appointment with movement specialist, but I am curious and of course *impatient*. Will likely be months before I see someone. Thx!
1. Foot problems. Born with them. When learning how to walk, dragged one foot all the time. Have had flat feet, much pain, and spasms ever since. Spasms can pull the toes into weird positions. Can pull big toe outward. Little toes curl downward. Spasms happen only on action. Always walk on outside edges of feet now. Can put them flat, but hurts like you wouldn't believe.
2. Pulse doesn't speed up enough when initiating exercise or when changing elevation. Have had many instances of passing out.
3. Exercise intolerance. Causes exhaustion, increased muscle spasms.
4. Muscle spasms happen anywhere in body now (recent change). Worse when sick, using certain drugs, or cold/hot.
5. History of depression.
6. Twitches, both skin and joint moving kind. Joint moving occurs in hands, feet, shoulders. Fingers accidentally tap buttons when resting over a mouse or keyboard. Twitches stop on voluntary movement.
7. Slight trembling on occasion. Feel it more than see it.
8. 12ish year old rash. Constant yeast infection. (please god someone explain that one) No history of diabetes. Have seen many docs about it but still have it.
9. Speech problems. Forget syllables, slur, rush words, mumble. Seems slowly progressive.
Strong history of familial tremor, just to add a dash of spice.
Main doc getting me an appointment with movement specialist, but I am curious and of course *impatient*. Will likely be months before I see someone. Thx!
Doctor's Answer
by CCF-Neuro-M.D.-SH, Jan 19, 2007 12:00AM
First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
The symptoms that you describe are not specific for one disorder, but I can outline an approach to your condition. A dopamine responsive dystonia generally begins in the first decade of life with a gait disturbance (usually with toe walking) and progresses to involve all 4 limbs by the 2nd or third decade. The dystonia has a diurnal variation, with little to no symptoms in the morning, with worsening symptoms towards evening. As the disease progresses the dystonia can occur throughout the day. The most outstanding feature in dopamaine responsive dystonia (DRD) is that it responds dramatically to sinemet (levodopa/carbidopa). Many cases that present similiar to what you describe have a broad differential including cerebral palsy, leukodystrophy, Wilson's disease, Pantothenate Kinase associated neurodengeneration (PKAN), etc. An initial approach is often to give a trial of sinemet to see if the symptoms improve. I would also suggest some tests to evaluate for the other diseases that I mentioned including: MRI of the Brain (for cerebral palsy, leukodystrophy, PKAN), serum copper/ceruloplasmin (for Wilson's disease). I agree that you should see a movement disorder specialist that will be able diagnose you properly. As far as the long standing rash/yeast infection, I would suggest that you be screening for immunodeficiencies, some people are not able to defend well against certain organisms (a heme/onc doctor or infectious disease doctor may be more helpful with this).
I hope this has been helpful.
The symptoms that you describe are not specific for one disorder, but I can outline an approach to your condition. A dopamine responsive dystonia generally begins in the first decade of life with a gait disturbance (usually with toe walking) and progresses to involve all 4 limbs by the 2nd or third decade. The dystonia has a diurnal variation, with little to no symptoms in the morning, with worsening symptoms towards evening. As the disease progresses the dystonia can occur throughout the day. The most outstanding feature in dopamaine responsive dystonia (DRD) is that it responds dramatically to sinemet (levodopa/carbidopa). Many cases that present similiar to what you describe have a broad differential including cerebral palsy, leukodystrophy, Wilson's disease, Pantothenate Kinase associated neurodengeneration (PKAN), etc. An initial approach is often to give a trial of sinemet to see if the symptoms improve. I would also suggest some tests to evaluate for the other diseases that I mentioned including: MRI of the Brain (for cerebral palsy, leukodystrophy, PKAN), serum copper/ceruloplasmin (for Wilson's disease). I agree that you should see a movement disorder specialist that will be able diagnose you properly. As far as the long standing rash/yeast infection, I would suggest that you be screening for immunodeficiencies, some people are not able to defend well against certain organisms (a heme/onc doctor or infectious disease doctor may be more helpful with this).
I hope this has been helpful.
This is one of my problems whenever I go see a doc: I forget stuff. Grr...
I do not have diabetes. I have been tested 4 times, including during pregnancy. I simply don't have it. More than one doc has thought the same thing - diabetes often causes yeast infections - but nope, nothing but negative test after negative test.
I've tried all the alternative methods, too, including raw yogurt.