Myoclonus - medication toxicity?

I am a 40 year old female, weight/height proportional, quit smoking a year ago, and do not drink alcohol. I am bi-polar II and have taken lithium for many years to manage it. I have, off and on, added citalopram when an anti depressent was needed. I have not taken any citalopram for almost two years. I had a benign tumor removed from my breast a year ago, with no complications. I have not been in any accidents or have I had any head injuries. I do have a history of outer ear infections, but otherwise am in good health. I exercise regularly and watch what I eat.  Most of the time.

Five months ago, I began feeling off balance. It got to the point that I could not walk in a straight line and would tip and stumble when I was walking. This was soon accompanied by a speech dysfunction (?) I could 'see' a word in my mind, but the word that came out was completely unrelated. I would think car, but say ball. Or I could see a word (almost like a billboard) but couldn't say it. I would have to say "that thing with wheels that you put a baby in" (stroller). Along with this, I began having twitches in my back. Not painful, almost like when someone comes up behind you and pokes your sides with their fingers. They became more intense, causing me to throw my arms up and utter a 'huh' like the breath was knocked out of me. My kids would call them my dance moves. (Have to have a sense of humor).  The doctor said it was myoclonus due to lithium toxicity. He did blood work, my levels were in normal range. He sent me to have an MRI and then to a neurologist. MRI was normal and the neurologist said my balance was BPPV and my twitches were lithium related.

My symptoms went away before I changed my lithium dose. A few weeks after there were no symptoms, my ARNP and I dropped the lithium dose to 600mg a day and added lamictal. Over the past five months, I would have very, very rare twitches, and they were mostly when I was trying to say a word and it was 'stuck'. I would stutter a bit, twitch, then say the word. Last week the heavier twitching returned and again my doctor said it was lithium toxicity. He is also sending me for an eeg. He perscribed my clonopin which I took a total of three over a four day period and then quit as my twitches went away. I have an appointment with a neurologist on the 4th. I'm concerned that there will be nothing that will show up, as my twitching has dissapeared for now. (I have not changed my lithium dose)

Also, I do have a sensation before I twitch, almost like a buzzing up my legs and back. Sometimes I feel that if I move or arch my back or roll my neck I can head the twitch off. Sometimes it just makes it less intense. I do not have tremors or twitches anywhere else.

The psych I see says that these are not psychological. It doesn't fit the criteria - I don't fit the criteria.

Sorry this is so long, I wanted to get as much info out. I am nervous about going to another neuro - the last one I saw told me to just lower my lithium, it wasn't like I would turn into 'crazy bipolar lady".  Actually it is through a pretty strict maintenence of medication that I am NOT crazy bipolar lady. I'd hate to go back to where I was before.

Anyone?  Thoughts and advice are much appreciated.

Regards,

Jane

[reddal]

Hi Jane, I feel sorry for the situation you're in. But let's be positive. There's a cure for everything (even for things doctors said there's no cure of). I think your doctor put it right that it is myoclonus due to lithium toxicity. Even stress alone (without medication) could cause muscle twitches. Long exposure to medication may build up a level of toxins in your body. Toxins may cause problem to kidney, and problematic kidney may cause twitches. Toxins also becloud your clear thinking. I'm not trying to scare you. Once again, there's a cure for that.

The best natural cure I believe is releasing toxins off your body. You have a long life ahead of you, and you don't want to keep building up toxins. When your body is cleared off of toxins, your organs will start to coordinate better, building better immune system and will be able to do what a normal healthy body does, drive away anomalies as soon as it begins.

I don't know how severe your problem is that you've been taking lithium for so long. Still there's nothing wrong with giving yourself a chance for a healthy diet and a bit of excercise. You've got nothing to lose there.

that is all i can say so far. my best wish to your health.

[theasian]

myoclonus, so much "fun". i've also got it, but in my case we have absolutely no idea what's causing it. it can be caused by a whole variety of things, like your doc syays it may be from the lithium but there are other things, from somethign as simple as a vitamin deficiency to something more serious like a tumour. i'm on epilim and lamictin to keep it under control.
if there's something wrong with the "wiring" in your brain, it would show up on an eeg regardless of whether you are having the twitches or not (at least that's my understanding of things)
take care