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Diagnosed progressive freezing gait disorder. Have muscle spasm, balancing difficulty and micrographia. On Syndopa and Donep. Suggest?

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Nov 2013
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I have been diagnosed for "progressive freezing gait disorder" Symptoms include :1) gait initiation, 2)muscle spasm and 3) balancing difficulty while standing and turning while walking and 4) micrographia . However i do not have the typical PD tremor. I am able to drive a car and ride a scooter. Currently medication ; Syndopa Plus (2+2+0) and (Donepezil) Donep-5 (1+0+0). No success on gait and balance front, but reasonably effective on muscle spasm .. Any alternative medication suggested ?
Posted Thu, 26 Sep 2013 in Headache and Migraines
 
 
Answered by Dr. Sudhir Kumar 1 hour later
Brief Answer:
Detailed reply is below

Detailed Answer:
Hi Mr Dwarak Ethiraj,

I have noted your symptoms and gone through the MRI reports of brain and spine.
There are no significant findings on MRI, which can explain your symptoms.
So, the diagnosis has to be a clinical one, based on history and examination.
I agree with the diagnosis made by your doctor.

In addition to the medications you are using, pramipexole and selegeline may be added. I would add one at a time to see the effect. Pramipexole is usually started at a dose of 0.125 mg twice daily and the dose can be gradually increased.

In addition, coenzyme Q10 may also help, usually given at a dose of 300 mg twice daily.

Physiotherapy with gait and balance training would also help.

I hope it helps.

Please get back if you require any additional information.

Best wishes,

Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, Hyderabad,
My personal URL on this website: http://bit.ly/Dr-Sudhir-kumar
My email: YYYY@YYYY
My blog: http://bestneurodoctor.blogspot.com/

Above answer was peer-reviewed by
 
Follow-up: Diagnosed progressive freezing gait disorder. Have muscle spasm, balancing difficulty and micrographia. On Syndopa and Donep. Suggest? 18 hours later
1. With regard to Syndopa dosage i am currently taking is there any other way of administration like a "patch"? I was told there is something available abroad but would not know the name or brand, hence this question.

2. If above is true then what are the advantages and long term implications of that alternative

3.Are there any surgical options available for treatment of my conditions that can be examined ? If so what are the essential prerequisites for deciding ?
 
 
Answered by Dr. Sudhir Kumar 14 minutes later
Brief Answer:
Detailed answers are below

Detailed Answer:
1. As far as I know, there is no patch available for Syndopa (levodopa carbidopa combination). However, there are methods to administer it in the gut directly in people who can not swallow.

2. The dose of syndopa may be adjusted (increased or decreased) as per the symptoms and side effects.

3. Deep brain stimulation (DBS) may help in some cases, but in your case, it would not help. DBS helps those with predominant tremors or those with levodopa induced dyskinesia (abnormal movement of hands and legs).

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
Follow-up: Diagnosed progressive freezing gait disorder. Have muscle spasm, balancing difficulty and micrographia. On Syndopa and Donep. Suggest? 11 hours later
Dear Dr. Information on patch can be found at http://www.neupro.com/ . I am trying to get more information, including actual experience , but may not be able to do so within the the time limit open to me for a discussion with you.
 
 
Answered by Dr. Sudhir Kumar 5 hours later
Brief Answer:
Neupro is not syndopa

Detailed Answer:
Thank you for getting back.

Neupro is not levodopa/syndopa. Neupro is Rotigotine, which is a new drug for treating Parkinson's disease. Neupro patch is going to be available soon in India too, however it may take a few more months. XXXXXXX pharma is working on getting this patch to India.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
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