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Dr. Andrew Rynne

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Suggest treatment for intermittent myoclonic jerks

Answered by
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Dr. Dariush Saghafi

Neurologist

Practicing since :1988

Answered : 1503 Questions

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Posted on Tue, 29 May 2018 in Brain and Spine
Question: I recently started having myoclonic jerks, they started at sleep onset and waking then progressed to anytime I laid down, now occationaly while sitting. My appointment is not for another 3 weeks. Is there a way to get faster care?
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Answered by Dr. Dariush Saghafi 6 hours later
Brief Answer:
Unfortunately, it will depend upon how many neurologists are in your area

Detailed Answer:
Good evening. Your specific question is difficult to answer as a neurologist who lives in the State of Ohio since you live in OK but the phenomenon of not being able to get in to see neurologists is something that occurs all over the country. I was in contact with a patient in XXXXXXX who told me that it would be 7 months before she could see the only local neurologist in a 350 mile radius and over 1 month until she could even get an MRI of the brain.

In the XXXXXXX OH area the average wait time to see neurologists is around 2 months. I can tell you that in my case I always make additional time available for patients who have more urgent problems and myoclonic jerks that are increasing in frequency would be one of those instances. Personally, I get patients in to see me within 1 week or less and have even opened my office on Sundays and Holidays to see additional patients with more urgent problems.

Therefore, it really depends on the availability and flexibility of the neurologists in your area. If I were in your position, I would simply open the phone book....or the Internet....and start making phone calls to each office listed. Sometimes other patients will cancel appointments and if you are in the right place calling at the right time you may be able to slide in to one of those spots.

The alternative would be to contact the nearest ACADEMIC TEACHING HOSPITAL and explain your desire to be seen more urgently. Sometimes academic centers have more neurology availability due to the presence of resident doctors who manage weekly clinics. In this case you may be able to get into either a GENERAL NEUROLOGY CLINIC or an EPILEPSY clinic to be further evaluated.

Of course, if you're in the market for taking a quick jaunt to XXXXXXX Ohio I would be happy for you to have a conversation with my office who can make special arrangements to be seen right after the New Year.

If I've provided useful and helpful information to your questions could you do me a huge favor by CLOSING THE QUERY and be sure to include some fine words of feedback along with a 5 STAR rating? Again, many thanks for submitting your inquiry and please let me know how things turn out.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 16 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Dariush Saghafi 24 minutes later
what tests would you recomend to get a diagnoses?
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Answered by Dr. Dariush Saghafi 9 hours later
Brief Answer:
Details below

Detailed Answer:

Here we go....

Well, workups for new onset myoclonic jerks would have to take metabolic issues into considerations first and foremost. I don't know who diagnosed you with the myoclonic jerks in the first place (ER, Urgent Care, PMD?) but typical bloodwork that is done involves initial bloodwork and urine to look for evidence of toxic elements of either an infectious nature or kidneys that may not be working properly. For example, anybody who has kidney disease which progresses due to things such as diabetes mellitus, or toxic heavy metal exposure may be expected to start having myoclonic jerks as CREATININE and BUN start rising beyond certain levels in the bloodstream.

Here is an initial set of bloodwork that I would order then, in your case of MYOCLONUS of new onset.

CBC w/differential, Comprehensive metabolic panel, Hemoglobin A1C, Ionized calcium in serum, ESR, C reactive protein, heavy metal screen, thyroid panel (TSH, FT4), random cortisol, serum Vitamin D, B12, serum Magnesium (Total and Free fractions).

I would also look at the urine:

Urinalysis with Culture and sensitivity, (if urinary protein or albumin were present I would get a more comprehensive kidney panel).

Of course, there is another step I would also go through even before we hit these labs and that would be to carefully go through your medication history if you are on any meds for any other conditions and find out if you're taking any drugs that could cause myoclonic jerks or which could be metabolized into chemicals that your body is simply not reacting well to, etc. Which drugs can cause such a state? Just about all of them...depends on the person's biochemistry...so we'd go through a medication checklist in order to rule that out as a cause of your problem right out of the gate.

After that initial blood and urine were completed....if that didn't yield anything....I would next order an EEG (electroencephalogram) and I would likely also get an MRI of the brain with a seizure protocol.....but I'd be very careful if going this route which requires GADOLINIUM XXXXXXX to be injected that we cleared the kidneys of any dysfunction as I said above these could be the initial source of problems. We would run a special set of tests for the kidney apart from what I've mentioned to include an EGFR and Creatinine index and I would require that the EGFR>60 before agreeing to use GADOLINIUM CONTRAST...otherwise, the MRI can still be done of the brain...but without the XXXXXXX component.

This would be my initial and secondary workups in a patient with myoclonus to try and discover if it were metabolic/hormonal or otherwise, chemically/medication induced and treatable.....or if you were developing some form of myoclonic epilepsy...and then, if that were the case....you'd need more neurological attention to see what if any inborn errors of metabolism or other problems could be afoot.

The vast majority of cases turn out to be metabolic or medication induced so that's where the money goes in terms of probabilities in a case such as yours.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others. I hope they can get this problem resolved for you and get you in to see a neurologist or other doctor in a more timely manner....as I said before the invitation to join us here in XXXXXXX in the New Year is always another option?

Cheers and Happy New Year!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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