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To Quix or anyone who can help--Questions about neurological symptoms
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To Quix or anyone who can help--Questions about neurological symptoms

I have also posted this in the neurology forum.

I’ve been having unexplained symptoms for over a year. They started when I was taking antidepressants. I am not sure if there is a connection between the symptoms and the antidepressants or if the symptoms are anxiety related (all in my head) or the symptoms just happened to coincide with the antidepressants and are due to something else. I am not denying that I have some anxiety and was depressed, I was and I still have some depressive tendencies but overall my outlook is much better and with counseling I am working on putting things into perspective. I have had several tests which have come back negative (MRI, visual evoked potentials, EEG, thyroid). The doctor doesn’t have any answers for me yet and is concerned the symptoms may be a result of anxiety. Any information you could give me to help me get to the bottom of this would be greatly appreciated. I tried 3 different antidepressants over the course of a year: Zoloft 50mg, then Celexa10mg, then Lexapro 5mg. Each time I took a new one I would start off fine but after a couple of months I would feel sedated, groggy, dizzy and clumsy. I had memory problems (brain fog, confusion, problems concentrating, trouble coming up with the right word) difficulty waking up and in spring of ‘’06 I started to  slur my speech frequently. I am getting older but the memory problems came on suddenly. I stopped taking the antidepressants in June‘’06. The sedated feeling went away, the slurred speech gradually got better and went away after about 6 months but the clumsiness, fatigue, difficulty waking up, and memory problems remain. What might be causing my symptoms? Would a sleep disorder be causing my symptoms?

Symptoms that remain:

Clumsiness, can’t get a good grip/drop things, (it’s like my hands have a mind of their own/there is some kind of disconnect). It happens more often when I am trying to wake up, fatigued or in a hurry.

Occasional dizziness with sudden head movements

Memory problems (brain fog)

Unrefreshing sleep, very fatigued, come home from work exhausted, no energy. I can’t get things done like I used to. Waking up is now very difficult; this did not used to be difficult for me. I go to bed at 9 or 10 & get up at 5:30. I sleep in until about 7 on the weekends. I used to have some insomnia but this hardly happens now. I’m so tired I usually fall right asleep. My husband tells me I snore. Just a week ago I tried the Breathe Right nasal strips and have noticed it is a little easier to wake up in the morning. I  find that light exercise helps a little bit but it doesn’t energize me. I have a stressful job (I work with young children with behavioral/emotional problems).

I have had an increase in severity, duration, and frequency of migraine headaches. I have had migraines since childhood but my migraines have gotten worse and are now coming more often (2x per month) and lasting 2 or 3 days, they used to go away after a good night’s sleep. The migraines consist of a painful throbbing on the right side of my head behind my eye. I wake up several times a night with the pain. I am sensitive to light, sound, smells, and sudden movement. It doesn’t happen every time but if it is really bad I will vomit. I have tried three different medications with inconsistent results. Sometimes the medication will work for a day but it will come back the next morning. Often it will take the edge off but the headache doesn’t go away until it runs its course. The doctor just put me on daily 20 mg Propranolol, it is too soon to tell if it is working. I take no other medications.

Other information—My maternal grandmother had chronic progressive MS. Occasional heart palps which increase with caffeine and stress. I’m 43 female, about 50 lbs overweight, and don’t smoke or drink. I don’t drink coffee and have cut back on caffeine but I drink 2 caffeinated diet sodas (w/Splenda not asparatame). My father, sister and son have all been recently diagnosed a genetic platelet aggregation disorder and thrombocytopenia. I was screened but came back negative. I have low iron and heavy periods. I have palpable anterior lymph nodes in my neck but don’t feel any throat pain. I have had for several years something that is hard to explain. It is like an arm heaviness. It is difficult to have my arms be on their own without support. I prop my arms on pillows. It seems to be worse after a long time on the computer, holding a book for a long period, etc.

MRI without contrast findings-No midline shirt. The ventricles are normal in size without hydrocephalus. There is no evidence of intracranial mass or infarction. No acute ischemia on the diffusion-weighted scans. No significant white matter disease is present.

Spinal MRI with contrast-Alignment appears intact. Disk heights are well maintained. No significant bone marrow lesions noted. Accounting for mild artifact, the cervical spinal cord has normal thickness and signal intensity. There is a small central disk protrusion at C5-6 with minor mass effect. Given its small size and location, it is unlikely to cause significant nerve root impingement. A minor posterior disk bulge is noted at C6-7.

Nocturnal Polysomnogram:
Sleep efficiency was 69.1%
Stage 1 sleep 7.1%
Stage 2 sleep 55.3%
Stage 3 sleep 8.7%
Stage 4 sleep 0%
REM sleep 28.9%
Total sleep time 329 minutes
Non REM sleep was 240.5 minutes
REM sleep time was 95 minutes
Latency to persistent sleep was 17 minutes
Latency to REM sleep was 162 minutes.
not much snoring
4 respiratory events
RDI of less than 1/hour
nadir oxygen saturation 95%
no cardiac events
heart rate went up to 115 beats/minute
1 plm arousals and 26 awakenings

Blood tests
B12—324 pg/mL
Ferritin—16.7 ng/mL
Iron—45 ug/dL
Hemoglobin A1c—5.2%
Glucose—125 mg/dL (but I had not fasted)
TSH reflex—1.15 uIU/mL
TSH—1.00 uIU/mL
Free T4—1.1 ng/dL
Free T3—3.0 pg/mL
Acetylchol receptior—0.0 nmol/L
Related Discussions
5 Comments Post a Comment
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199882_tn?1310188142
You are definetely prepared for anything.  That's great.  I have MS and some of the things that you describe are the same as me.  On the other hand my husband has sleep apnia (apnea) and a whole lot of your symptoms sounds just like him.

It has come to my attention that anything relating to MS type symptoms is extremely hard to diagnose.  Unless you have significant lesions and all, it takes the process of elimination to determine weather or not it's MS.  

I'm sorry that I'm not any help but I do wish you the best of luck. Oh, by the way I also suffer from chronic pain which is due to severe nerve damage in my feet and legs.  Do you suffer from alot of pain?  

I pray you get a dx real soon,

Carol
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147426_tn?1317269232
Hi, Again I'm sorry to have been absent when you arrived.  I read your post a couple times.  What jumped out at me in the beginning were the symptoms you developed on the three anti-depressants which were all SSRI's.  Are those the same symptoms that you were being treated for?  By this I mean did your depression show up with grogginess, dizziness, clumsiness?  I have seen a lot of "stuff" online about certain people reacting badly to SSRI with onset of neurological symptoms.  I haven't specifically researched it, but it wouldn't surprise me.

The cognitive function difficulties can be an underrecognized presentation of MS, but also occur in many othe disorders.  Yes, a sleep disorder, can cause everything you have mentioned.  It can cause all the cognitive problems, exacerbate depression , and is classic for increasing frequency of migraines.

I can't evaluate the sleep study numbers.  It's not something I ever learned and right now I'm not able to do the research.  I'm needing to limit the reading I do.  There is a sleep technician over on the Neurology Support Forum (I think).  Maybe we could find him/her by doing a search above on the orange block - upper R hand corner of this page.  Maybe we could tease some knowledge out.  They've offered interpretations before.  But I think you are supposed to have some Stage 4 sleep.  That I will look up tomorrow.

the other lab tests are hard to interpret without your lab's normal range.  What is your Hg/Hct (hemoglobin concentration and hematocrit)?  Anemia can cause cognitive dysfunction, aches and pains and sense of muscle weakness, memory problems - all because of cellualr dysfunction because of low oxygen-carrying capacity.

What is the name of the genetic disease?  With parent, sib and child having it I would want to check if it is possible for you not to have it.  Given a history consistent with platelet dysfunction and a history of iron deficiency anemia a recheck (and not a "screening test" is in order.  When I know the name I can look up and see if you can not have it, yet pass it on.

I agree that the description of the MRI doesn't sound like it accounts for your problems.

Dizziness when you move your head may well be a type of positional vertigo.  I recommend that you see a subspecialist of neurology called a Neuro-Otologist.  They specificall deal with vertigo/dizziness.  Is the dizziness caused by the "movement " of your head or the "position "of your head.  Is it a vague feeling or a whirling?  You canfind the name of a neuro-otologost in your state by going to the VEstibular Disorders of America VEDA website ) vestibular.org and searching fro a provider.

I hope this helps a little.  If you could answer a few of my questions, maybe I'll have some ideas.  Quix
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I studied sleep disorders in one of my classes.  I'm not exactly sure of this number, as I approximated it from a chart of a typical pattern of the stages of sleep during a single night.  However, it appears that in a typical night's sleep of 8 hours, about 2 hours, or 25%, is spent in deep sleep, or stages 3 and 4.  A much greater proportion of deep sleep occurs in the first half of your total sleep than in the second half.  These stages involve the least amount of brain activity.

You only slept about 5 1/2 hours.  Still, I would think that the percentage should be the same or greater.  You only spent 8.7% in stage 3 sleep and got no stage 4 sleep.  Maybe that's why you wake feeling unrefreshed?

S~
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Quix,

Thank you for your reply. I appreciate your help and time to research this.  I hope you are well.

I did not have grogginess, clumsiness, memory problems, or difficulty waking up before I took the antidepressants.

When I went in to discuss the results of my sleep study the doctor said my symptoms were all due to anxiety. He did not mention to me that I had no stage 4 sleep. I only found that out when I later requested my medical records.

Here are the normal ranges for my lab which were done in March ‘07:
Ferritin 10-291 (mine was 16.7 ng/mL)
Hemoglobin A1c  4.0-6.0 (mine was 5.2%)
Iron 30-150 (mine was 45 ug/dL)
B12 247-911 (mine was 324 pg/mL) this one was done in Oct. ‘06

Other blood tests I had in August of 2006:
White blood count 6.8 K/uL (my lab’s normal range is 4.0-11.0)
Red blood count 4.49 M/uL (3.80-5.20)
Glucose 125 mg/dL (65-99) I had not fasted
Platelet Count 175 K/uL (150-400)
HCT 41.2% (35.0-46.0)
HGB 13.7 g/dL (11.6-15.5)

Thyroid tests:
Free T3  3.0 pg/ml (2.3-4.2) on 8/7/06
Free T4  1.1 ng/dL (.8-1.6) on 8/7/06
TSH 1.00 uIU/mL on 8/7/06 and1.24 uIU/mL on 6/23/06 (.40-5.0)
TSH Reflex 1.37 uIU/mL (.35-5.5) on 3/25/05
TSH reflex 1.15 uIU/mL (0.40-5.00) in March ‘07

The bleeding disorder is complicated. My father, sister’s and son’s hematologists have all said we have an interesting case. There is more going on with the platelets than simple Von Willebrand’s. They are still in the process of an official diagnosis. All three have low platelet counts. My sister was told she has Type1 Von Willebrand disease, probable congenital thrombocytopenia, and platelet dysfunction consistent with storage pool disorder.  My son has a platelet aggregation disorder with mild thrombocytopenia. My son’s hematologist seems to think it is one diagnosis rather than two (something quite rare) but so far she has not been able to determine it yet. She sent my son’s labs to the Mayo Clinic but we haven’t heard back yet. My son’s hematologist said I might have the bleeding disorder as well since my son, father and sister have it but I have only had one set of labs done in July ‘06 and they came back normal.

Von Willebrand Panel:
Factor VIII Assay 101% (55-150)
Von Willebrand Fact AG 67% (50-165)
VWF ACT (Rist Cofac) 56% (>40)
Von Willebrand Factor VIII Activity 113% (56-190)
Von Willebrand FAC AG 64% (51-185)
Von Willebrand ACT 70% (44-195)

I do get occasional dizziness when I move my head (a whirling feeling) but this is not a very common occurrence for me anymore. It has reduced significantly since my symptoms began.

THANK YOU AGAIN FOR YOUR TIME.
Gromit
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147426_tn?1317269232
Yes, indeed your family's hematologic disorder is complex and interesting.  I, too, have Von Willebrands Disease, Type I (by far the most common).  So do my father, sister and her daughter.  Low platelets can be seen (often intermittently) in the variant of Von Willebrand's, Type IIB.  As you probably know, the protein (Called the Von Willebrand's Factor ) is reduced in type I.  People just don't make enough.  In the various II type the protein is defective and doesn't function correctly to clot normally.  If it is type IIB, the disorder is what is called "autosomal dominant".  So if your parent has it and your son has it, then so do you.

I noted that all the important factors are near the bottom of the normal range, including the platelet count.  Yes, it is in the normal range, but barely.  Though, I am not a hematologist and this is definitely not a field of expertise, I suspect, with your history of heavy periods and iron-deficiency, you DO have it and the testing missed it.  The thing about the Von Willebrand's factor is that it can vary in levels from minute to minute.  Many people with the disease have normal (usually low normal) and need repeated testing to carch it low.  Children who become stressed and frightened during the blood drawing process, can have their VWF shoot up into the normal range.  I've seen it over and over.   Things like stress and estrogen will cause it to elevate temporarily.  Though it is "theoretically possible" to suppose that your sisiter has more than one hereditary, bleeding disorder seems a little silly.

Also in type I, which is probably not the case, but I don't know about the other types, the level of VWF varies with blood type.  People with O may have lower levels and the ranges need to be reported with respect to the ABO blood type.  LOL, I'm sure you can tell that my family has recently been through this.

It appears to me that your doc dropped the ball on the interpretation of the sleep study.  Without deep sleep you can't recover the fresh, rested feeling.  It is critical to proper function during the day and I think this needs to be peursued, possibly with another neuro.  There are also common meds, like Benadryl, and OTC sleep aids, which can effectively block Stage 4 sleep and cause ongoing problems.

Sherri, Thanks SO MUCH for jumping in with you knowledge of sleep studies.  Good job!

Back to the iron deficiency.  Your iron stores remain low, though you no longer have anemia.  However, relative deficincy in iron levels can show up in kids' behavior and performance in school.  They often learn poorly, are distractable and have low energy even when the blood count has come up.  The other brain symptoms persist until the iron stores come up farther.  This I know as a former pediatrician.  Keep taking your iron.

I hope this has been helpful.

Quix
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