myoclonus & benzodiazipines

[JC-Quinlan]

    
      Re: myoclonus & benzodiazipines
    


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Posted by ccf neuro M.D.* on November 23, 1997 at 11:41:14:

In Reply to: myoclonus & benzodiazipines posted by J.C. Quinlan on November 02, 1997 at 17:22:31:
  My question involves myoclonus.  I was diagnosed with myoclonus about one month ago by a neurologist specializing in movement disorders.  I was referred to him by my psychopharmacologist (at McLean Hospital) because I was complaining of twitching and jerking movements throughout my whole body, but especially in my neck, face and head.  (These movements are virtually imperceptable to anyone but myself.) I was and am deathly afraid of tardive dyskinesia.  In an effort to "calm me down", my doctor sent me to this specialist (also at McLean).  Well, he understood what I was describing and made the diagnosis.  I am wondering if this in any way could be symptoms of tardive dyskinesia.  I am being prescribed 1,800 mg of Neurontin, and that seems to be helping a bit.  It has lessened my anxiety and therefore decreased the occurrence of the twitches.  Also I have cut back on my caffeine intake, which has also helped a lot.  The neurologist told me this came from my six-year addiction to Xanax, Ativan, and Klonopin.  Is this possible?  If so, can you please explain how this happens?  And, is the medication I am receiving appropriate, and is the dosage safe?  My other problem relates to my mouth.  I am wondering if this mouth problem is related to the myoclonus.  The symptoms are that my mouth continually feels "anxious", like it has to be moving, like chewing gum, etc.  It's kind of like it feels tremulous.  Also, I have been having a problem speaking.  My pronunciation is off, and it takes a lot of effort to form words correctly.  Oftentimes I remain silent because of this problem.  It is not that my tongue or lips are moving uncontrollably, but that my mouth doesn't seem to function properly when I attempt to speak.  I am sure I notice it far more than those around me, but I know that something is wrong.  It's just the most bizarre thing.  I don't know if it's neurological or psychological (because I am an extremely anxious person), or what.  Can you please give me your thoughts on this?  Thank you.  (I should probably tell you what medications I am currently taking: Paxil, 40 mg; Clonidine, 0.1 mg t.i.d.; Flexeril 10 mg daily; Neurontin, 1,800 mg daily; and Zyprexa, 2.5 mg every other day.)  Thanks a lot.
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Hello J.C.

Tardive dyskinesia is a movement disorder whose manifestations usually consist of involuntary, irregular movements of the tongue, mouth, and chin. Often the affected persons tongue will protrude in and out, mouth will twist around etc. Such symptoms are always easily noticable by the patient and others watching im/her. Tardive dyskinesia results from ususally prolonged exposure of the brain to neuroleptic drugs such as haloperidol, perphenazine, thorazine, fluphenazine etc. Such drugs are used to treat major psychiatric disorders such as schizophrenia, and other disorders with active hallucinations and/or psychosis. The disorder should not result from exposure to benzodiazepine drugs such as lorezepam (Ativan), alprazolam (Xanax), or diazepam (Valium). The benzodiazepine drugs are potentially addicting, however, and withdrawal symptoms can occur in those who are addicted. Myoclonus can result from anxiety pure and simple, as well as from seizure disorders, certain drugs, and some other rare neurologic diseases. Usually it consists of single or occasionally multiple brief, lightning-like jerks of the affected parts of the body. Myoclonus can normally occur as one is falling asleep. Smaller twitches like those you get in your arm or eyelid, are usually from what is called a fasciculation, which is the spontaneous discharge of a group of muscle cells that are all supplied by the same nerve cell. These also are most often due to anxiety. When a person is taken off of antianxiety drugs that they have been previously addicted to, it is natural to expect an increase in some of the symptoms of anxiety, and in each person these symptoms can be very different, and often include real, physical symptoms such as fasciculations and myoclonus, stabbing pains in the chest and abdomen, irritable bowel, an inner sense of restlessness (akathesia) that is often very difficult to put into words, and hyperventilation resulting in finger and toe numbness off and on. Thus, as you can see, it is not easy to draw that very artificial line between mind and body, as they are closely linked. Buspar is a nonaddictive medication used to alleviate chronic anxiety that often results in effective relief of anxiety-related symptoms, although it does not work especially well for panic attacks. Anxiety-related myoclonus is not usually worth attempting to treat in and of itself. Please remember that the information we provide on the forum is intended for general informational purposes. The actual diagnosis, treatment, and management of your specific medical condition should be strictly in conjunction with your treating physicians. If you would be interested in a second opinion from a Cleveland Clinic staff neurologist, the appointment number is 1-800-223-2273 extension 45559; ask for movement disorders (Dr. Burns) in this case. We hope you find the information helpful.