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Neurology (Expert Forum)
Intermittent Dyskinesia?
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Intermittent Dyskinesia?
by shimmo12, Mar 03, 2005 12:00AM
I began having tongue twitching in June 2004 while taking a dopamine agonist (domperidone) for irritable bowel syndrome. As soon as I went off the drug, the twitching quickly went away, but returned in mid-January 2005 out of the blue. I was taking Allegra 60 mg per day at the time and low-dose Naltrexone 1 mg per day, and stopped the Allegra since I know antihistamines can cause dykinesia. I have contineud taking the Naltrexone for IBS. The twitching has continued intermittently since, stopping for several days at a time and returning in various places on the tongue. Sometimes it happens for a few seconds, sometimes off and on for hours. Can dyskinesia come and go like this, and return after seven months of going off a drug? I'm also afraid of ALS, as I read tongue twitching can be a symptom (I don't have speech or swallowing problems, however). Thanks.
Doctor's Answer
by CCF-Neuro-M.D.-PW, Mar 03, 2005 12:00AM
I cannot give you a clinical diagnosis over the internet
The tongue twitching you decribe, if it is more like a writhing, smacking or repetitive nonsynchronous movement, it may be a dyskinesia rather than a 'twitch' or a 'fasciculation'. A twitch would be a rapid (single or multiple) movement of a small group of muscle fibers. A fasciculation is a slower movement of all the fibers of one motor unit (all the muscle fibers derived from one motor cell in the spinal cord). I am not sure completely which one you mean, and without seeing it, my advice is limited
Dopamine ANTAGonists like some anti-nausea medications and some anti-pyschotic drugs can cause dyskinesias or abnormal movements as above. Usually it stops with cessation of the drug, but sometimes it can recur/persist, and is called "Tardive Dyskinesia". The reason is unknown for it to recur, and it can be difficult to treat. It is more likely to occur with prolonged use, and with higher potency antidopamine drugs but can occur more rarely with smaller amounts. You should avoid further use of dopamine antagonists. ALS seems unlikely, but I cannot confirm this over the internet.
It would be a good idea to seek an evaluation from a movement disorder specialist, due to the difficulty in treating the tardive dyskinesia. If you are in the area, the Cleveland Clinic Movement Disorder Center can help you.
Good luck
The tongue twitching you decribe, if it is more like a writhing, smacking or repetitive nonsynchronous movement, it may be a dyskinesia rather than a 'twitch' or a 'fasciculation'. A twitch would be a rapid (single or multiple) movement of a small group of muscle fibers. A fasciculation is a slower movement of all the fibers of one motor unit (all the muscle fibers derived from one motor cell in the spinal cord). I am not sure completely which one you mean, and without seeing it, my advice is limited
Dopamine ANTAGonists like some anti-nausea medications and some anti-pyschotic drugs can cause dyskinesias or abnormal movements as above. Usually it stops with cessation of the drug, but sometimes it can recur/persist, and is called "Tardive Dyskinesia". The reason is unknown for it to recur, and it can be difficult to treat. It is more likely to occur with prolonged use, and with higher potency antidopamine drugs but can occur more rarely with smaller amounts. You should avoid further use of dopamine antagonists. ALS seems unlikely, but I cannot confirm this over the internet.
It would be a good idea to seek an evaluation from a movement disorder specialist, due to the difficulty in treating the tardive dyskinesia. If you are in the area, the Cleveland Clinic Movement Disorder Center can help you.
Good luck
