Dystonia

[Julie-Henze]

    
      Re: Dystonia
    


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Posted by CCF Neuro MD on January 28, 1998 at 21:46:34:

In Reply to: Dystonia posted by Julie Henze on January 28, 1998 at 21:03:26:

: In September of 1995 my son at the age of 10 was diagnosed with ADD.  
  He was prescribed Ritalin 5mg. three times a day.  In November of 1995,
  we noticed a slight turning of the left foot.  X-rays were done which did not
  show any problem.  I questioned the ritalin, but his doctor did not feel
  this would be causing the problem and thought it was attention seeking
  behavior.  By the end of the summer in 1996, my son could hardly walk without
  dragging his leg or going down to his knees. We also noticed spasms in that leg.
  We contacted a neurologist who ordered an MRI of the brain and the complete spine.  The results of the test
  indicated a diffuse disk bulging at L4-5.  A second MRI was performed secondary
  to movement during the first MRI, only this time it was of the brain.  The
  results indicated an inferior displacement of the cerebellar tonsils to the
  inferior aspect of C1 meausring 17mm, which stated was compatible with a
  Chiari Type I malformation.  There was no evidence of a syrinx in the upper
  cervical cord.  An X-ray of the lower spine was also addressed for the possible
  herniated disc from the previous MRI.  The x-ray indicated a partial sacralization
  on the left of the fifth lumbar vertebrae with a mild lumbar scoliotic curvature
  to the left.  There was narrowing and periarticular sclerosis involving the right
  L5-SI facet joint.  No associated spondylolysis was identified.  Impression form the
  report reads imcomplete pars defect seen at L5-S1 level on the right.
  An EMG and an SSEP were performed which showed problems at the level of L5.
  Finally outcome: Dystonia.  During the summer months of 1997, we spent the whole
  summer in serial casting after Botox injections to correct plantarflexion and
  inversion of the left foot.  A splint was to be fabricated with no luck secondary
  to the heel of the foot raising up when walking.  He had recieved another botox injection in
  July which gave no relief.  Currently he is taking 60mg. of Lioresal and 125mg. of sinemet.  We still have no relief,
  and the right foot is now involved, plantarflexion with inversion.  Minor
  relief is evident.  No one can give us the reason for this, and I have questions relating back to the spinal
  cord problems previously seen in the MRI.  I would like to have some input to
  this problem and a possible referal to the Cleveland Clinic.  In final, I would
  like to mention, in September upon returning to school, I noticed the Ritalin
  increased the spasms in his left leg and stopped giving him the Ritalin.  I
  would also like to mention, he is otherwise a health 12 year old, but has gone from using
  crutches to the use of a wheelchair because of the fatique and the increase
  of spasms after 10-20 feet trying to walk.  I would appreciate your input.
  ***@****
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it is unclear as to exactly how we can help you at  this stage as you
have not asked any specific questions,please try to identify specific areas
in which you want us to provide factual information and we will do our best
to provide thew information.
In the mean time I have located a case report fron the Journal of Child Neurology
January 1994, which reports dystonia after the initiation of Ritilan,
the case reported responded to treatment with Tegretol (carbamazepine.
There are certain aspects of your story which do not fully add up, for instance
dystonia is a centrally mediated disorder arising from the brain and is not
usually attributed to peripheral structures like nerve roots or the spinal cord.
This is overall a very complex case and i would encourage you to have a full
review including review of all MRI films in our Child neurology department which has
a very strong record in the area of ADD. If you wish to have an appointment to review your case preoerly
outside the obvious limitations of this forum the number for appointments for pediatric neurology is
( 216 ) 444 5559.