Any information appreciated

Posted by Laura on June 27, 1999 at 09:37:00
About 7 weeks ago I thought I had an ear infection.  At the same time I experienced twitching in my upper right eyelid.  My GP sent me to an ear/nose /throat specialist who looked in my ear and apart from finding it a little redder (the right ear) found nothing. I began experiencing facial numbness, involving all my face except for the chin.  In the last few days things seem to have gotten a good deal worse.  I have constant headaches but they are not especially painful and they seem to be not in the same area.  My hands are now involved, feeling numb and heavy but tingling.  I often find myself disoriented and experiencing some memory loss.  Typing is difficult at times and my spelling seems off when it is bad.  I am a 45 year old female, and I am an organic farmer.  I am stumbling and clumsy now.  My GP is trying to get me an appointment with a neurologist, but it could take some time to get one.  The right eyelid still has spasms and sometimes the lower left eyelid is involved.  Also in the last week I am having a lot of nausea.  I do not have any allergies, and have enjoyed excellent health til now.  As it may take awhile for me to see a neurologist is there anything I can do in the meantime, and what might be causing this?

Posted by Ian Umland on June 28, 1999 at 09:13:17
I think mmy question on this forum, entitled "continual numbness" has been overlooked.  If somone could respnd it would be greatly appreciated.
Thanks,
Ian

Posted by Donna on June 28, 1999 at 10:58:46
I am sorry to tag onto someone else and if you do not answer, I will understand.  I have read and re-read everything in the archive(s) and on this page.  
What I can't seem to find is:   If you get ALS or MS, do you wake up one morning feeling fine and by that afternoon have intense burning, pain, spasms, constanct twitching, and tingling in one arm.  By the next day, you are sore all over - in addition to the 1st day symptoms.  Do your thighs and calves feel sore?  What if the twitching slows down in the arm, but spreads to many other spots in the body - at a very infrequent rate.  What do you mean by weakness?  My thighs get tired going up and down steps - but I can take a nice brisk one mile walk.  Do the symptoms come and go?  If you are twitching constantly in one spot - and within 3 days - it slows to nothing or stops altogther in that same spot - what does that mean?  
Can antibiotic drugs cause reactions like this?  I have read another site and corresponded with people who have had reactions to Quinolone drugs.  Plus - at the same time I was using Flonase - a nasal spray corticosteriod.  I have also read studies on this.  Have you seen this before - from an ADR or from a combo of these 2 drugs?
I will also say that my left eyelid twitches quite a bit - and was doing so three weeeks before the medication.  However - all other symptoms started after 7 days on the meds.  The  onset was acute and symptoms have been going on for 1 week.  Does ALS or MS happen this fast?  
Thanks Donna

Posted by Donna on June 28, 1999 at 11:53:34
I did not mention,  but the quinolone drug I was taking was CIPRO at 750mg per day for a bacterical infection of my toe.

Posted by CCF MD mdf on June 29, 1999 at 00:05:15
Donna: Posting an unrelated question in a follow-up is not a great idea because the original question can get answered and your own may be completely overlooked. It's also not archived in the right category, so others don't get full benefit from your question and answer.
No. ALS and MS do not present with sudden onset of burning pain and tingling in one arm. ALS is strictly a motor neuron disease, with either no sensory symptoms or only very subtle ones. It is typically painless. MS has a multitude of symptoms, but this would be very unlikely.
Weakness is defined as the inability to generate full power contraction of a muscle or group of muscles. It is not the same as fatigue. Some people with certain types of incoordination believe they are "weak" because they can't control their limbs as well as they would like, but that is a different issue.
Twitching? Hard to pinpoint the exact phenomenon without an examination. So I can't really say if this is fasciculations or what. However, when there is pain, it is not uncommon for muscles to spasm in a normal reflex reaction (happens all the time around the spine).
I am unaware of this phenomenon happening with quinolones or inhaled (nasal) steroids.
Eyelid twitching is usually normal. In rare circumstances it reflects an injury to the facial nerve (cranial nerve 7). Your scenario doesn't really fit that.
Chances of your having ALS or MS are quite low, given the data at hand. But you should see a neurologist just to get a thorough neurolgic screening exam. If no pathology is uncovered, you can breathe easier.
From the story, your neurologist will consider the possibilities of pinched nerve in the neck (cervical radiculopathy) or possibly fibromyalgia, or even just an old-fashioned viral illness which made you feel crummy. I can't speculate any further in this forum.
I hope this helps. CCF MD mdf.
Posted by Donna on June 29, 1999 at 08:47:56
Thank you very much for answering my question.  I am sorry that I tagged on to someone else.  I had a friend that passed away from ALS so I was quite aware of what muscle twitching could become - but I didn't remember him being in pain, at least in the beginning.  He was only 28 when he died and was quite healthy until it started.  I guess I became scared and desperate.  I am improving each day - it just seems to be a slow process.  Again, thanks.

Posted by Kevin on July 11, 1999 at 01:23:43
Donna,
You may want to get a hold of the following studies:
Peripheral Sensory Disturbances related to Treatment with Fluoroquinolones by Karin Hedenmalm and Olav Spigset, Division of Clinical Pharmacology Norrland University Hospital, Sweden.   Journal of Antimicrobial Chemotherapy (1996) 37,831-837
Aoun, M. Jacquay, C. Debusscher, L. Bron, D. Lehert, M. Noel (1992) Peripheral Neuropathy Associated with Fluorquinolones Lancet 340, 127.
Also you can read about other cases reported on the Quinolones Antibiotic Reaction Forum by doing a search for the forum using the Excite Search engine.
While it is always important to rule out all possible causes and see a neurologist and other specialties for appropriate care and diagnosis,  many neurologists and other specialities are unfamiliar with many of the CNS and Peripheral Nervous System effects of many drugs including Quinolones.  Some of the Clinical Pharmacology Colleges seem to have some insight as well as a few NIH docs...
All the best to you.      

Posted by CCF Neuro[P] MD, RPS on July 12, 1999 at 11:23:35
Dear Kevin:
You are correct that one of the side of effects of the quinolones is a peripheral neuropathy.  It has been documented and is even in the product insert as a side effect.
Sincerely,
CCF Neuro MD