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Neurology (Expert Forum)
Spastic jerks in right leg followed by head jerking
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Spastic jerks in right leg followed by head jerking
by Olanda, Mar 12, 2007 12:00AM
34 y/o female no health problems, until October 2006 when I began to experience constant fatigue. FT college student and thought it was the stress of school, therefore when the semester ended in December I was glad to finally be able to get adequate rest. However the exhaustion continued and I began to develop extreme thirst, and blurred vision...saw PCP at the beginning of the year and was diagnosed with diabetes (Type II) blood sugar was 589. I’m able to keep my sugars down. I’ve experienced leg twitches, headaches, head jerks and terrible pain in my spine (neck area) several per hour since Jan - When I went to see my PCP he told me to stop taking my Lexapro which I did and my symptoms seemed to be resolving. However now it’s been three weeks since I’ve been off the Lexapro and the leg twitching (primarily R leg) has resumed and when my R leg twitches my head will jerk at the same time, only lasting for 2-3 seconds. I have terrible pain in my inner ankles like bone on bone rubbing together. Sitting in a chair for longer than a ½ causes a great deal of pain in the back of my thighs and legs as if I have no circulation but my legs aren’t purple. My hands also sporadically twitch and sometimes it’s painful to try and make a fist. My doctor says the chances of me having diabetic neuropathy this early in my disease is extremely unlikely and we’ve run a gamut of test (EEG, EMG, HIV, tons of blood work) everything has been negative although he did say my TSH was a little low. Any suggestions or questions that I should ask the neurologist when I see him. Thank you
Doctor's Answer
by CCF-Neuro-M.D.-SH, Apr 04, 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 and story that you present sound complex and there is much data that I do not have. However, if I assume that the EEG, EMG etc were all normal, and going by your description of the 'jerks' these sound like myoclonus. This is a rapid jerk taht causes a brief jump in your arm or leg and can have a number of different causes. The most common is metabolic imbalances or a reaction to a medication (especially narcotic pain medications). A medication called Klonipin (clonazepam) can often be helpful in suppressing myoclonus, but the cause should be looked for as the first order of buisness. The pain that you describe makes me concerned about something called diabetic amyotrophy. This causes severe pain (usually the person cannot find a comfortable position no matter what), often associated with weight loss (10-15 lbs) and is common at the initial presentation of diabetes. The good news is that it is generally self limited (although it may last for 6 months to 1 year). Diabetic amyotrophy has been treated with steroids and/or IVIG in the past, but there is not a lot of evidence to support this. I would sugges that you go to a neurologist that specializes in neuromuscular neurology at a major academic center to be re-evaluated.
I hope this has been helpful.
The symptoms and story that you present sound complex and there is much data that I do not have. However, if I assume that the EEG, EMG etc were all normal, and going by your description of the 'jerks' these sound like myoclonus. This is a rapid jerk taht causes a brief jump in your arm or leg and can have a number of different causes. The most common is metabolic imbalances or a reaction to a medication (especially narcotic pain medications). A medication called Klonipin (clonazepam) can often be helpful in suppressing myoclonus, but the cause should be looked for as the first order of buisness. The pain that you describe makes me concerned about something called diabetic amyotrophy. This causes severe pain (usually the person cannot find a comfortable position no matter what), often associated with weight loss (10-15 lbs) and is common at the initial presentation of diabetes. The good news is that it is generally self limited (although it may last for 6 months to 1 year). Diabetic amyotrophy has been treated with steroids and/or IVIG in the past, but there is not a lot of evidence to support this. I would sugges that you go to a neurologist that specializes in neuromuscular neurology at a major academic center to be re-evaluated.
I hope this has been helpful.
Thanks