HealthCareMagic is now Ask A Doctor - 24x7 | https://www.askadoctor24x7.com

What Causes Severe Muscle Spasms, Nerve Pain And Numbness In Extremities?

Posted on Fri, 1 Jul 2016

Question: Hi I am currently on 400mg of topamax per day originally for migraines (started 15 yrs ago). However, I suffered a CHI 10 yrs ago with resulting seizures and went through several other primary anticonvulsants and was recently switched to keppra, 1500mg daily. I just discovered that these meds do have a reported interaction. I checked on this because I have been ill for a couple of years, but really ill for the past 6 months, with numbness and nerve pain of my extremities. This then became muscle spasms of upper and lower extremities, chest, back, neck, and face, with nerve twitching off and on. I was recently hospitalized with chest pain and dyspnea, cardiac and pulmonary disease as well as pvd was ruled out. I believe it was caused by the muscle spasms in my chest, but the Drs in the hosp did not want to hear it. They would not even send a neurologist to do an eval. I have also had pneumonia and multiple uti's. I know, long story! My question: do you think it would be worthwhile to taper off my topamax? I am on a wait list to see a neurologist. Thank you

Answered by Dr. Neeraj Kumar (45 minutes later)

Brief Answer:
Get some investigation as advised and taper Topiramate

Detailed Answer:
Hello,
I have gone through your question and understand your concerns.
For migraine other medications are also available like Flunarizine, Valproate, amitryptiline.
Topiramate may be reduced in dosage as it can lead to nerve problems.
Vitamin B 12 and vitamin D levels should be checked for muscle spasm if other investigations are normal.
Drug changes should be gradual and preferably under guidance of a doctor.
Levetiracetam can be continued for seizures.
Hope you found the answer helpful.
Do get back to me for further queries.
Regards
Dr N Kumar
Neurologist

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Neeraj Kumar (4 days later)

Thank you for your reply. I am tapering off my toprimate slowly. (I have been an RN for 30 years.) I have also been having dysphagia and have lost 20lb in the past 6 months. I am 5'2" and 110 lbs. I would like to have ALS ruled out, not that I am being hysterical, just want to know. Do you think I have a valid question?

Answered by Dr. Neeraj Kumar (10 hours later)

Brief Answer:
Get examined by neurologist and get investigated too.

Detailed Answer:
Hello,
Amyotrophic lateral sclerosis is characterized by wasting, fasciculations of muscle along with increased muscle tone.
The diagnosis is made on clinical ground with electrophysiological support. Nerve conduction study and EMG play an important role.
Severe dysphagia, difficulty in protruding tongue and speech changes can be found in ALS.
Topiramate also leads to decreased appetite and weight loss.
Neurologist examination is must for diagnosis.
Hope you found the answer helpful.
Regards
Dr N Kumar
Neurologist

Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Yogesh D