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Suggest Medication For Ataxia While On Ritalin

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Posted on Mon, 16 Oct 2017
Question: My partner is in hospital as he has ataxia - he stumbles at times and walks with an unsteady gait plus his right forearm has become so itchy on and off and when it flares it becomes almost unbearable to resist the urge to scratch and cold towels and a cold athlete spray is the only relief. They have identified a few white spots on his spine around C6 and C7 on an MRI and a small white spot on his brain so far though the neurosurgeon still doesn't have a prognosis and ordered more thorough scans. He had a car r the rear side of his van 3.5 months ago and he hit his head on side window and that is when he started to stumble occasionally and about 2 weeks ago he rapidly got worse and at times it is a struggle to walk - he is 56 and otherwise fit non drinker and non smoker and takes low doses of Ritalin and another medication for depression since a nasty divorce 8 years ago and adult diagnosed ADHD - he is a tradesman and worried about his future ability to work. None on the Doctors so far acknowledge that the itchy forearm may be connected to the C6 and C7 lesions hoowever I have found positive information in USA medical journals that there is evidence for the connection- appreciate we must wait for test results however do you have any ideas about his symptoms and potential prognosis- have you seen this before?
doctor
Answered by Dr. Dr. Muhammad Sareer Khalil (2 hours later)
Brief Answer:
Unlikely to be related to the cervical spine lesions

Detailed Answer:
Hello and welcome,

I appreciate your concern,

Based on your description, the localized pruritus is unlikely to be related to the cervical spine lesions or a systemic cause.

Local irritant or contact dermatitis should be looked for. Skin patch testing can be advised to determine the cause and advise treatment accordingly.

The cervical lesions can be associated with paraesthesia and numbness but unlikely to be pruritus.

Please let me know if you have any query regarding,

Wishing both of you the best of health

Thanks


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Dr. Muhammad Sareer Khalil (1 hour later)
Thank you Doctor


You may be interested to read this article
And also do you think that trauma from whiplash to C6 C 7 could be the cause of the gait problem otherwise what is the relationship between spots on spinal MRI, problems with Balancec and the likely treatments?:
Extracted from here: http://getbetterhealth.com/is-a-compressed-spinal-nerve-causing-itchy-arms/2011.10.15
A new study exploring the cause of brachioradial pruritus was just reported in the October issue of the Journal of the XXXXXXX Academy of Dermatology. The authors used MRI imaging to look at the cervical spine of 41 patients suffering from chronic itching of what was otherwise normal appearing skin on the outer surface of their forearms arms (called brachioradial pruritus). MRI imaging showed a very strong correlation between the itch and nerve compression in the patient’s neck. In fact, the exact site of the itch on the skin correlated precisely with the spinal location in the neck where the nerve resides that supplies that part of the arm skin (we call this a dermatome*).
What’s so interesting is that the only sign of the nerve compression in the spine was the itchy skin ‘down stream’ in the exact nerve root dermatome of the spinal nerve that was compressed. When we think of nerve root compression in the spine we expect pain, numbness, decreased muscle strength and many more symptoms to be present, not just itch. These patients, however, did not have neck pain or other signs that we doctors would associate with spinal disease, they just had itchy skin ‘down stream’ from the nerve!
We already knew that severe spinal disease (disk herniation, spinal tumors etc.) can result in itch that’s seen in the ‘down stream’ dermatome of skin supplied by that spinal nerve, but it also includes a host of other symptoms (pain, numbness, paralysis etc). Now we are finding that even subtle nerve root compression can cause just this vexing itch without all the other symptoms. We’re still not sure exactly why the itch happens in a compressed nerve because the itch nerves are usually quiet unless something is tickling or biting the skin. The authors of the study speculate that the slight compression may be making the itch nerves ‘hyper-excitable’. They point out that the dermatome of skin with the subtly compressed nerve has altered sensory perception to pinprick and temperature suggesting that the nerves really are ‘tweaked’ by the compression.
What else did we learn about the arm itch (brachoradial pruritus) from the 41 patients studied?
In every patient a skin biopsy showed completely normal skin, confirming that the itch was not due to a skin problem. They did see changes common to chronically scratched skin (leathering, callous like lesions, scratch marks), but no rashes or skin problems that could cause itch.
There was often burning and stinging sensation at the site as well as itch
The itch got worse with warmth and heat (This is interesting because for years we’ve known that brachoradial pruritus is often worse in the summer. We attributed it to sun exposure but perhaps the real trigger is heat.)
The itch was improved by applying something cold (i.e. an ice-pack)
The itch often started in the dermatome of the nerve that exits the spine at cervical (neck) vertebra #6 (This nerve root supplies the outside surface of the forearms, over the brachioradial muscle, called dermatome C6.). Over time the itch often grew to several adjacent dermatomes and the spinal issues and nerve root compressions were found in those dermatomes too when that happened.
In most people the itch was constant 24/7, but in some it occurred intermittently
In about half of the patients it was on both arms
doctor
Answered by Dr. Dr. Muhammad Sareer Khalil (18 hours later)
Brief Answer:
Explained

Detailed Answer:
Hello again

Yes, issues with balance and gait are possible with cervical causes e.g Cervical spondylosis is a cause for vertigo.

Thanks for uploading the related article. Yes, it is a surprising correlation. If indeed the skin is normal with no allergic response along with specific spinal lesion correlation with the pruritus then pregabalin and gabapentin or tricyclic agents like amitriptyline should be advised to look for empirical improvement. If indeed its neuropathic then its likely to respond to these agents.

Wishing you best of health

Thanks

Let me know if you have any query

Please consult your doctor before deciding on any further course of action.

For future follow up / correspondence you may ask me directly at the link given below

http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=68107

Dr. M.S. Khalil

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Dr. Muhammad Sareer Khalil

General & Family Physician

Practicing since :2012

Answered : 2906 Questions

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Suggest Medication For Ataxia While On Ritalin

Brief Answer: Unlikely to be related to the cervical spine lesions Detailed Answer: Hello and welcome, I appreciate your concern, Based on your description, the localized pruritus is unlikely to be related to the cervical spine lesions or a systemic cause. Local irritant or contact dermatitis should be looked for. Skin patch testing can be advised to determine the cause and advise treatment accordingly. The cervical lesions can be associated with paraesthesia and numbness but unlikely to be pruritus. Please let me know if you have any query regarding, Wishing both of you the best of health Thanks