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Medicine for neurological disorder - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Brain and Spine
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2586 Questions
User :   I am a young man, just turned 31 years old. About a year and a half ago, I started to develop a slight tremor in my left forearm/hand. Over time, the tremor has gotten more exaggerated. Just recently I have noticed that my left lower leg/foot has felt heavy and stiff and I cannot move or rotate my foot as well as my right one. I have jogged a couple of times recently and although, while running I was okay, afterwards, this caused lower back ankle/foot pain. When I stand or walk for an extended period of time, I have pain in my lower back and ankle/foot. Sometimes when turning my head quickly, I get a pinching type pain in my neck on both sides of my neck.
When I sleep, the tremor goes away. When I wake up with the sensation of pins-and-needles in my arm from sleeping on it, although it is numb, as it normally would be, I have complete use of my hand and fingers, normal dexterity, without the tremor, until normal feeling comes back, usually up to about 5 minutes. The more relaxed I am, it seems, the less the tremor. But the stiffness or lack of dexterity of my fingers stays the same. Also, a drink or two of alcohol suppresses the tremor.
As a twelve year old, I had scoliosis surgery, placing rods in my back, from “T-4 to the end plate of T-10 and T-11 through L-3’. Also, about 10 years ago, from a target shooting gun accident, I have a .22 caliber bullet fragments remaining in my upper left arm. At first, we thought the bullet fragments were the cause since only my lower left arm was affected but since the EMG shows normal nerve conductivity and now that my left leg seems to be affected we don’t think this is a factor..
I was told, when I had the scoliosis surgery that possibly, down the road, I could experience problems from my neck. Currently, as stated earlier, I get some neck pain and stiffness and lower back pain. Earlier, in the summer, after
User :   doing some strenuous yard work, I had acute lower back pain that lasted for several weeks. I took Skelaxin, a muscle relaxer, which helped. This is the first time I have ever had that extensive pain in my back.
We have been to several different neurologists, without much success. I have had a brain MRI done, a neck MRI, 2 different EMG’s, extensive blood work and an EEG done as well. All reports are included. You will see that the Brain MRI shows normal. The EMG shows that the nerves and muscles of my lower arm are normal. The blood work and EEG are normal as well. The Neck MRI is, we believe now is the area of focus, as the report says that I have “significant reversal of the cervical lordosis and a moderate to large, right sided disc herniation at C6-C7. The neck problems seems to have been overlooked to date by doctors as originally, the diagnosis was that I had an anxiety related tremor because when I concentrated on something else, the tremor went away, briefly. Also, there was some concern from just one of the doctors that it may be Parkinson’s disease. However, most of the doctors felt that the frequency of the tremor, 10 Hz doesn’t suggest it. Also, in trying Cararbidopa-levodopa, 25-100MG tablet, which should have stopped the tremor, if it was Parkinson’s, did nothing but made me nauseous. It had no affect on the tremor.
Speaking of medicines, to date, I have been prescribed the following medications with literally no results. Starting from earliest date to most recent…Trihexyphenidyl – 2MG, taken twice daily – (this made me dizzy, headachy,weak.)Pramipexole Dihydrochloride, (Mirapex) - .5MG, taken 1 tab, 3 times daily – (this caused diarrhea)
Lorazepam - .5MG, taken one tab, twice daily. (this lessened the tremor slightly for just
a day or two but it kept me awake).Carbidopa-Levodopa – 25-100MG, taken 1 tab,
User :   three times daily, (Made me very Nauseous, with no affect).Clonazepam - .5MG tab, taken 1 tab, twice daily. (no affect)
Amantadine – 100MG, taken 1 tab twice daily. (Lessened tremor for just a day or tow but then made me nauseous, headachy).Propranolol – 20MB tabs, taken 1 tab daily. Since there was no affect, this was Increased to 3 tabs, 3 times daily. (No affect at either dosage).
Prednizone – Tried a metered dose pack to see if it would reduce inflammation hoping
to reduce the tremor some. (There was no significant affect).     
I am currently not taking any medications other than occasional Advil for pain in my lower back and neck stiffness. Additionally, I tried acupuncture for 8 appointments. While on the table, relaxing, the tremor went away, then, after getting up, the tremor came back.
Doctor :   Hi,
User :   hi there i wrote alot soory
User :   sorry
Doctor :   please give me a couple of minutes to read your post
Doctor :   no, its very good as you give more information , clearer we understand and help you
Doctor :   ok, i had been through history
Doctor :   please brief me your question
User :   what could cause this left arm tremor since all the major symptoms have been considered could it be the disc herniation in neck there are three
Doctor :   yes, i did consider it being the cause
Doctor :   parkinson is a wrong diagnosis, what you have is a intentional tremor
User :   i tried levadopa and it made me instantly sick so thats how i know its not park
Doctor :   yes, i cosider it to be a UMN Upper motor neuron lesion ,
Doctor :   which often results due to incomplete compression of the spinal cord
User :   plus when i drink liquar it doesnt shake but its stiff
Doctor :   detailed work up about the disk herniation would provide a lead
Doctor :   yes, as alcohol supresses the CNS influence which is passes through the pyramidal tract ( UMN )
User :   whats weird is when my arm falls asleep and there is no feeling i have complete use of the arm and hand without shaking
Doctor :   a wake brain tries to pass information through the pyramidal tract but probably due to the compression the signals become abnormal
Doctor :   its atually the subconscious part of the brain involved
User :   the nuero doctor said that the three discs are slightly touching the cord but not a normal tremor for that they say
Doctor :   hence when those subconscious influences are withdrawn by liquor or sleep the signals come down leaving it symptom free
Doctor :   may be repeating MRI with thinner slices will help
User :   so the disc herniation is the major cause cause all other tests came back normal but the neck
Doctor :   and your symptoms too are in favor of the fact cause being in the neck
User :   so thats the major cause could it cause distonic like symptoms
Doctor :   yes, the UMN type lesion as i said
User :   whats umn
Doctor :   Upper motor neuron
User :   i thought the neck is lower
User :   can it affect the leg stiffness too
Doctor :   the root values involved c6 and c7 also indicate the same
Doctor :   yes,
User :   well thanks for your help
Doctor :   cord passes to lower limbs after supplying upper limb
Doctor :   thanks for consulting
Doctor :   bye
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