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Which treatment should I follow as i am having two different etiologies?

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General & Family Physician
Practicing since : 2009
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After my last pregnancy and live birth having cardiac arrest at 32 weeks and being dx'ed with inferior vena caval syndrome at 36 weeks, then 5 concurrent miscarriages, acute cholecystitis ending in a lap-chole, being dx'ed with Trigeminal Neuralgia, peripheral neuropathy, parathesis and most recently (within the last week) severe motor nerve cramping all on my right side, increasing memory deficits, right eye vision loss and right ear tinnitus, ALL IN THE LAST FIVE YEARS plus the recent uncovering that Budd-Chiari was responsible for my maternal aunts' death after a liver transplant, I am having difficulties receiving concurrent treatment.

The Hughes syndrome specialist believes that the neuropathic damage has been caused by TIAs' but the neurologist will not "get on board" with that dx as my last MRI only showed one lesion in the left prefrontal cortex.

I had to go to the ER tonight due to nerve misfirings (spasms) in my muscles that would seize up my entire right side. The neuro insists that they are spasms and not seizures but the Hughes Doc feels the reverse. The ER doc was in a difficult position but prescribed Baclofen with no relief. I started Gabapentin two days ago, been on Tegretol and Quentiapine for nearly 6 months. I am getting the blood work done tomorrow for Hughes syndrome.

My question is how do I manage my care and my acute pain between two disputing specialists who believe entirely two different etimologies?
Posted Tue, 17 Apr 2012 in Brain and Spine
Answered by Dr. Vidya Muralidhar 2 hours later

Thanks for your query.

I understand your situation, that you are caught between the two diagnosis given by two different specialist.

The nerve misfirings could be a spasm or a seizure.As the ER doctor has examined you during the time of the event, his diagnosis would be more accurate.A seizure is well diagnosed clinically, however for a muscle spasm , one may need further investigations like EMG .

Since you have already tried baclofen, a muscle relaxant which has not been of much help, I suggest you to continue with Gabapentin as prescribed by the Hughes specialist.Gabapentin is known to take care of seizures as well as neuropathy of any cause.Hence I am of the opinion that this would be more beneficial to you than Baclofen.

Do not worry about what the diagnosis is.Since there have not been any blood tests, EEG, EMG done so far, one cannot certainly come to a definitive diagnosis.
The diagnosis is only provisional now.

The treatment and the response is what matters the most.I suggest you continue same treatment till you see the doctor for a review with reports.I feel Gabapentin will give you relief from the acute episodes of pain.

Hope this answers your query.I am available for follow ups as well
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