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Thread: Strange neuro symptom > Dr Wise?

  1. #1
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    Strange neuro symptom > Dr Wise?

    Hi All,

    I have Hereditary Spastic Paraplegia, tho' this hasn't been confirmed by the genetric test, it's just a *best guess* diagnosis, and treated as such with Baclofen and Tolterodene.

    As I also have symptoms that simply don't fit HSP, and my present neuro thinks I may also have a secondary, as yet undiagnosed neuro disorder. I saw him earlier this week for my regular check up, and told him that in the time since we last saw each other, I'd had perhaps six occasions where both legs went completely numb, each time for no longer than 30 seconds, but leaving me unable to move till they had passed. These happened without warning, I had done nothing out of the ordinary to bring them on.

    Not unsurprisingly, he was at a loss to explain why, or what the cause of this may be, his best guess (again) was that I'd had a short circuit of the nerves of some kind. Without him actually seeing this happen, I can see why he's unable to offer a explanation, but is there a neuro disorder where this is, if not common, at least a recognised symptom? As far as I'm aware, this doesn't occur with HSP, so perhaps it's just another manifestation of my other *mystery* neuro disorder.

    Ian

  2. #2
    Super Moderator Sue Pendleton's Avatar
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    Hi Ian, Hopefully Wise will jump in here soon. The only thing I know of with such a symptom is later stage Parkinson's but your neuro would have seen that on a simple exam.

    Could this be a side effect of the Tolterodene?
    Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

    Disclaimer: Answers, suggestions, and/or comments do not constitute medical advice expressed or implied and are based solely on my experiences as a SCI patient. Please consult your attending physician for medical advise and treatment. In the event of a medical emergency please call 911.

  3. #3
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    Hi Sue,

    It's highly unlikely to be caused by Tolterodene, nor Baclofen, as I've been taking both for a number of years with no side/ill effects (50mg Baclofen twice daily, 1 Tolterodene 4mg slow release daily)

    All these episodes happened in the space of a couple of months, and there's been no recurrence since, about three months now. They were just so unexpected, I had to mention them to my neuro, but hopefully it was just a phase and not indicative of future problems.

    I'm more curious as to what, if anything, they are a symptom of, particularly as my neuro thinks I *may* have a secondary disorder. It's possibly HSP related, but doubtful as I've remained constant in my symptoms for a number of years now, I can't see why things should suddenly deteriorate now, if in fact they have.

    Ian

  4. #4
    Quote Originally Posted by Ian B
    Hi All,

    I have Hereditary Spastic Paraplegia, tho' this hasn't been confirmed by the genetric test, it's just a *best guess* diagnosis, and treated as such with Baclofen and Tolterodene.

    As I also have symptoms that simply don't fit HSP, and my present neuro thinks I may also have a secondary, as yet undiagnosed neuro disorder. I saw him earlier this week for my regular check up, and told him that in the time since we last saw each other, I'd had perhaps six occasions where both legs went completely numb, each time for no longer than 30 seconds, but leaving me unable to move till they had passed. These happened without warning, I had done nothing out of the ordinary to bring them on.

    Not unsurprisingly, he was at a loss to explain why, or what the cause of this may be, his best guess (again) was that I'd had a short circuit of the nerves of some kind. Without him actually seeing this happen, I can see why he's unable to offer a explanation, but is there a neuro disorder where this is, if not common, at least a recognised symptom? As far as I'm aware, this doesn't occur with HSP, so perhaps it's just another manifestation of my other *mystery* neuro disorder.

    Ian
    Ian B,

    There are a number of conditions that present as with temporary periods of paralysis. I have not heard of temporary periods of numbness.

    For example, hyperkalemic periodic paralysis is something that is manifested by attacks of weakness lasting 10 minutes to an hour.

    http://www.hkpp.org/physicians/hyperkpp_dr.html
    Family history:

    Autosomal dominant inheritance (Statistically 50% of an affected person's offspring will inherit). All who inherit the most common genes develop symptoms (complete penetrance) but severity is very variable. There is reduced penetrance with mutations A1156T & M1360V. Age at onset: Infancy to second decade of life.
    Clinical signs:

    Attacks of weakness, lasting from 10 min to 1 hour, very rarely up to 1-2 days. Some patients experience only a few attacks of weakness in their lifetime, others have attacks of generalized weakness every day.

    The term 'hyperkalemic' is misleading since patients are most often normokalemic during attacks. It is the fact that attacks are precipitated by potassium administration that best defines the disorder...Diagnosis is suggested by a modest elevation of serum potassium during attacks in nearly half of patients; however at times the serum K+ is normal or even falls below normal. Serum sodium levels may fall as potassium rises. This results from sodium entry into the muscle. Water also moves into the cell causing further hyperkalemia. Hyperregulation may occur at the end of an attack causing hypokalemia, which may result in a misdiagnosis of hypokalemic PP. Water diuresis, creatinuria, and an increase in CK may also occur at the end of an attack. The so-called hyperkalemic and normokalemic entities of this disease are not separate entities.
    Cardiac signs and Emergency Treatment of an Attack

    Institute emergency treatment if EKG changes occur or serum K > = 7 mEq/L. EKG change sequence: tall peaked T waves, diminished R waves amplitude, increased QRS or PR intervals and P wave disappearance.

    There are many different kinds of "periodic paralyses" with some identified causes (Source). Focal seizures can cause transient regional paralyses and sensory disturbances. In fact, there is a name for such paralysis, called Todd's paralysis. Thyroid disease induced hypokalemia can also cause periodic paralysis but is not usually associated with sensory loss and tend to be manifested as early morning paralysis (Source).

    Finally, several drugs can cause temporary sensory loss. These include viagra, promethazine, vincristine... but I imagine that if you would have linked drug use to 6 episodes.

    Wise.

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    Hi Wise,

    Thanks for the detailed reply.

    I guess I'll just have to put these episodes down as to being a mystery.

    Without the neuros actually seeing one in progress and testing to see what was happening, they/I will never know. Even if they did see one, the short duration would suggest they'd be unlikely to have time find out anyway.

    One thing which did surprise me, was that as I was stood up each time, I didn't collapse when they occurred, but no, it was just both legs being numb.

    As my present neuro has such a limited knowledge of HSP, he's going to refer me to a doc with more interest/experience in this type of disorder. I'll mention these episodes to him and see what he has to say.

    Thanks again.

    Ian

  6. #6
    You are welcome. Let us know of any developments. Wise.

  7. #7
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    Hi Wise,

    Will do, but it'll be a few more weeks (maybe months) before I get the referral to see the new doc. The UK Health Service is great, but can be slow unless it's a emergency.

    Ian

  8. #8
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    Just a quick update on this.

    Yesterday I recieved a copy of the notes my neuro made of our last meeting. After telling me he was willing to refer me to another neuro, the notes say he is 'going to make enquiries about the numbness' which is not the same thing at all.

    I'm sorry to have to say this again, but he openly admits he knows little about HSP, and this numbness has just clouded the issue even further for him, and it appears he has no real interest in finding out the cause, if in fact he/they can.

    Ho hum...............

    Ian

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