Tardive Dyskinesia, Chorea or What

[mawmoo]

I am a 58 year old female.  First noticed little involuntary movements my left hand about Sept.  Got more frequent (movement like trying to grasp something) Even arm would get involved.  Was worse when under stress (my daughter was going through chemo), axious or tired. It stops when I'm asleep. Later noticed left foot has movement. Went to see a neuro(11/14)he diagnosed me with Tardive Dyskinesia prescribed Trihexyphenidyl 2 mg twice day, some lab and an MRI.On return visit he said MRI showed an insignificant spot on brain, told him meds made the movements worse. He said that was all he could do.(I quit the meds and him)(had been taking Reglan 10 mg a day for several years and Buspar 10mg a day since Aug)had already stopped taking them and stopped all my other meds (Nexium, Levisin, Prempro). Saw another neuro (1/26), She called my condition Chorea, prescribed Clonazepam and recomended a brace for my wrist,had me tested for copper and Huntingtons and wants another MRI to get a clearer picture(Follow up 2/28)(both tests came back fine)(MRI today) Went to see yet another neuro (3/14) recomended I see movement specialist (appointment not until  9/13) prescribed Baclofen.  Will continue with both Doctors  until I see movement specialist.  Any thoughts or suggestions?

[CCF-Neuro-M.D.-PW]

Your problem does lie in the realm of a movement disorer specialist, and you are correct in seeing one. A correct diagnosis is critical in terms of appropraite treatment and prognosis and you already know

Seeing the movements is critical to the diagnosis. If it does not occur constantly, videotape it and bring it to the specialist. This could be the difference between no diagnosis and diagnosis, and this is how they mostly diagnose movement disorders.

Tardive D, chorea etc all have characteristic appearance which should be immediately apparent to the experienced observer. As you have been on Reglan for a while you are at risk for TD, and treatment is limited to none unfortunately. Stay away from any further anti-dopaminergic medications (Regan, some other anti-nausea medication, anti-psychotics).

There are many causes for the other type of movements, which the specialist will be able to test for or filter through. Parkinsons can present with resting tremor in one limb, spreading to another, 3-5 times per second, absent when TOTALLY rested, and is responsive to medication like L-dopa or dopamine agonists such as ropinirole. Without seeing your movement though its very hard to tell. This tremor is more distal in the hand. Chorea is more proximal at the arm or shoulder level, for instance.

Good luck

[vega1318]

Good idea to see several neurology specialists for this problem.  Has anyone tested you for possible seizure activity with an EEG, especially while you were having these movements?  
Make sure you also get tested for vasculitis -- what were those "spots" they told you about?

[mawmoo]

Thank you for your response. Hand movement is almost constant.  Hand is stiff and swollen when I first get up.  Loosens up some after using it, but it primarily hurts all the time. Having trouble with everyday tasks (flossing teeth, fastening bra, opening medicine bottles) and even at my job (doing a lot of typing with just right hand) Second doctor thinks I have developed carpal tunnel from all of the movement, that is why she recommended the brace.  Third doctor says it's tendonitis. No one has suggested an EEG, What is that kind of test? What is vasculitis?  MRI (11/29/05..."1.0 cm focus of altered signal intensity in the posterior limb of the right internal capsule may represent an occult cerebrovascular malformation versus a small focus of hemorrhage.  CT scan of the head with and without contrast would be beneficial for further differention". (First doctor didn't suggest to follow up with CT scan, my new primary care suggested it)CT scan (12/15/05)  "Small ill-defined lesion in the right posterior vasoganglia is not particulary specific by CT scan.  Review of the MRI from 11/29/05 suggests that this lesion represents a small cavernous angioma."

[vega1318]

Very interesting finding on the MRI.   I would look into that cavernous angioma a little closer with a special doctor, such as an Interventional Neuroradiologist.   You might be having symptoms from this, usually  benign, problem.  It is in the correct location.  These can sometimes bleed and cause small local problems.

EEG is a test looking for a seizure focus.   Your story is somewhat unlikely to be the result of a seizure, though.   I would forget  that idea, even though I said it.  

Hope you feel better.

[herbacious]

A related discussion, quivering mouth was started.