FREE MOVEMENT OF MUSCULER IN PET- NUEROLOGY
TREMOR, TWITCHES, SPARSM -
Tremor
Tremor is the most common movement disorder in human and likely so in veterinary patients. In human medicine, tremors are classified on the basis of their location, association with rest or voluntary muscle contraction, frequency and amplitude of the oscillatory movements. Tremors can be divided into resting tremors and action-related (also known as kinetic) tremors. Resting tremor is present only during rest.
Tremor is the most common movement disorder in human and likely so in veterinary patients. In human medicine, tremors are classified on the basis of their location, association with rest or voluntary muscle contraction, frequency and amplitude of the oscillatory movements. Tremors can be divided into resting tremors and action-related (also known as kinetic) tremors. Resting tremor is present only during rest.
The most common example in humans is Parkinson’s disease secondary to degeneration of the substantia nigra. The condition has not been recognised in domestic animals. Action-related tremor occurs following initiation of voluntary movement and worsens with increasing levels of activity while it disappears with rest. Action-related tremor can be classified in veterinary patient as postural or kinetic. Other forms of action tremor related in human to specific movement of the hands and arms such as isometric or task-specific tremor are not recognised in our canine and feline patients. Intention tremor is a form of kinetic tremor. It is typically associated with cerebellar disease in small animals and usually observed with other cerebellar signs such as bilaterally symmetrical ataxia without decreased level of voluntary movement (paresis), vestibular signs (head tilt, nystagmus, loss of balance…), broad-based stance, dysmetria and absent menace response with normal visual placing and normal vision. Cerebellar-related tremor is usually the consequence of diffuse cerebellar disease process and predominantly affects the head with initiation of voluntary head movement. This type of tremor disappears when the animal is totally relaxed or sleeping. Generalised tremor can occur secondary to congenital disorders of myelination, metabolic conditions (hypocalcemia, hypo- and hypernatremia…), intoxications (metaldehyde, lead, pyrethrins, organophosphates, bromethalin, ivermectin, some mycotoxins…),storage diseases and inflammatory CNS diseases. Generalised tremors without other definable systemic cause are most often secondary to inflammatory brain disease. Such condition is most common in small white canine breeds (especially West Highland white terrier and Maltese) which has been the reason for the name “white shaker syndrome” initially given to this condition. However, dogs of any colour, size or breed can be affected and therefore the term ‘generalised tremor syndrome’ is now preferred. The onset is usually sudden with signs generally seen between 9 months and 2 years of age. On occasion, mild vestibular or cerebellar ataxia or other neurological signs accompany the diffuse whole-body tremor.
Imaging studies are usually normal and CSF may be normal or reveal a slight elevation of lymphocytes and protein. The few histologic studies of the CNS of affected dogs have revealed a mild, non-suppurative meningo-encephalitis in some. Postural tremor involves muscles that participate in maintaining the body against gravity (also known as postural muscles). The best postural tremor described so far in veterinary medicine is the orthostatic tremor (OT) occurring in giant breed of dogs such as Great Danes, Deerhound and Newfoundland. OT causes dramatic tremors that are visible only when the animal is standing. The tremors typically begin in the lower aspects of the legs, but can also involve the muscles of the head and face. The tremors are usually first apparent at a young age (1-2 years), and are unique in that affected dogs often appear reluctant to lie down and demonstrate what appears to be a constant “shivering” while standing suggestive almost of an involuntary dance. OT is different from other causes of tremors in that the tremors that are characteristic of the disease completely disappear when the dog walks, runs, leans against an object, or lies down. The tremors can be totally abolished when a standing dog is lifted off of the ground. Dogs with OT appear otherwise healthy on physical examination, and generally do not have any significant abnormalities that are detectable on routine blood tests, radiographic examinations, spinal fluid analysis, and even have normal MRI examinations of their brains.
Definitive diagnosis of OT requires documentation of the characteristic tremor pattern during a conscious electromyographic (EMG) examination. Intermittent head ‘bobbing’ is another less understood type of postural tremor affecting the head and neck postural muscles and causes a rapid head and neck tremor. The head ‘bobbing’ can be in the vertical or horizontal plane and typically disappears when the dog is distracted or lay down. It can occur as an idiopathic disorder or as a consequence of structural brain disease (especially with pathology affecting the thalamus). In older dogs, benign, rapid, postural tremor may occasionally be seen in the pelvic limbs. This tremor is only present when the dog is standing and disappears during voluntary movement. The aetiology and pathogenesis of this syndrome remains unknown.
Twitches
Myokymia is defined as a contraction of independent small bands or strips of muscle fibres which induce an undulating movement of the overlying skin (twitches). Compared to tremor, this involuntary muscle activity persists even during sleep and under anaesthesia. Generalised and focal forms of myokymia have been recognised in veterinary medicine with the focal form most commonly affecting the face. These myokymia can be caused by a wide variety of disorders of the CNS and peripheral nervous system (Distemper, demyelinating conditions, axonal voltage-gated potassium channels abnormality…).
Myokymia is defined as a contraction of independent small bands or strips of muscle fibres which induce an undulating movement of the overlying skin (twitches). Compared to tremor, this involuntary muscle activity persists even during sleep and under anaesthesia. Generalised and focal forms of myokymia have been recognised in veterinary medicine with the focal form most commonly affecting the face. These myokymia can be caused by a wide variety of disorders of the CNS and peripheral nervous system (Distemper, demyelinating conditions, axonal voltage-gated potassium channels abnormality…).
SIGN AND SYMPTOMS-
In mild cases, ET can manifest as the inability to stop the tongue or hands from shaking, the ability to sing only in vibrato, and difficulty to do small precise tasks such as threading a needle. Even simple tasks like cutting in a straight line or using a ruler can range from difficult to impossible, depending on the severity of the condition. In disabling cases, ET can interfere with a person's ability to perform tasks of daily living, including feeding, dressing, and activities of personal hygiene. Essential tremor generally presents as a rhythmic tremor (4–12 Hz) that occurs only when the affected muscle is exerting effort. Any sort of physical or mental stress will tend to make the tremor worse.[5]
The tremor may also occur in the head (neck), jaw and voice as well as other body regions, with the general pattern being that the tremor begins in the arms and then spreads to these other regions in selected patients. Women are more likely to develop the head tremor than are men. Other types of tremor may also occur, including postural tremor of the outstretched arms,intentional tremor of the arms and rest tremor in the arms.[6] Some patients may have unsteadiness and problems with gait and balance.
ET-related tremors do not occur during sleep, but patients sometimes complain of an especially coarse tremor upon awakening that becomes noticeably less coarse within the first few minutes of wakefulness. Tremor and disease activity/intensity can worsen in response to fatigue, strong emotions, low blood sugar, cold and heat, caffeine, lithium salts, some antidepressants, and other factors. It is typical for the tremor to worsen in "performance" situations, such as when writing a check for payment at a store or giving a presentation.
Parkinson's Disease and Parkinsonism can also occur simultaneously with ET.[1] In those cases the degree of tremor, rigidity, and functional disability does not differ from those people with idiopathic Parkinson's Disease. Hand tremor predominates (as it does in Parkinson’s Disease), and occurs in nearly all cases, followed by head tremor, voice tremor, neck, face, leg, tongue and trunk tremor. Most other tremors occur in association with hand tremor. Walking difficulties in Essential Tremor are common. About half of patients have associated dystonia, including cervical dystonia, writer's cramp, spasmodic dysphonia, and cranial dystonia, and 20% of the patients had associated parkinsonism. Olfactory dysfunction (loss of sense of smell) is common in Parkinson’s Disease, and has also been reported to occur in patients with Essential Tremor. A number of Patients with essential tremor also exhibit many of the same neuropsychiatric disturbances seen in idiopathic Parkinson's disease.[7]
TREATEMENT FOR TREMOR-
Not all individuals with ET require treatment, but there are many treatment options depending on symptom severity.[1] Caffeine and stress should be avoided, and good sleep is recommended.[1]
When symptoms are sufficiently troublesome to warrant treatment, the first medication choices are beta blockers such as propranolol or alternately, nadolol and timolol. Atenolol and pindolol are not effective for tremor.[1] The anti-epileptic primidone is also effective for ET.[1]
Second-line or third-line medications can be added if the first-line medications do not control the tremor. Second-line medications are the anti-epileptics topiramate, gabapentin and levetiracetam, or benzodiazepines like alprazolam. Third-line medications are clozapine and mirtazapine.[1]
When medications do not control the tremor or the patient does not tolerate medication, botulinum toxin or deep brain stimulation may be considered.[1] Occupational therapy can be helpful.[1]
Examples include propranolol, atenolol, nadolol, and metoprolol.
IF NOT RELIEF THEN USE primidone, topiramate, and gabapentin.
- Botox (OnabotulinumtoxinA) injections - especially if the head and/or voice are affected. Treatment is usually effective for about three months. Experts say that Botox should not be used to treat hand tremors because the muscles in the area may become weaker.
VEDIO LINKS-
http://www.youtube.com/results?search_query=medicine%20for%20SEIZURES%2C%20TREMOR%20AND%20TWITCHES&sm=3
Parkinson’s
disease in Dogs
Parkinson’s
Disease in Dogs Symptoms
Parkinson’s
disease in Dogs Treatment
What are the signs and
symptoms of essential tremor?
What are the causes of
essential tremor?
How is essential tremor
diagnosed?
What are the treatment
options for essential tremor?
What Are The Treatment Options For Parkinson’s
Disease?
Medication
Side effects of rasagiline may include:
Muscle twitching
(painless), Shaking hands or tremor and Weakness
Symptomatic drug therapy is available for
several forms of tremor. Drug treatment for parkinsonian tremor involves
levodopa and/or dopamine-like drugs such as pramipexole and ropinirole. Other drugs used to lessen
parkinsonian tremor include amantadine hydrochloride
and anticholinergic drugs.
Essential tremor may be treated with propranolol or
other beta blockers(such as nadolol)
and primidone, an anticonvulsant drug.
Cerebellar tremor typically does not respond
well to medical treatment.
Dystonic tremor may respond to clonazepam, anticholinergic drugs, and
intramuscular injections of botulinum toxin. Botulinum toxin is also
prescribed to treat voice and head tremors and several movement disorders.
· Medication should never be administered
without first consulting your veterinarian.
· The typical dose administered to dogs is
0.125 to 0.5 mg per pound (0.25 to 1.0 mg/kg) once to twice daily. The total
daily dose is often 6.25 to 25 mg/dog.
· The typical dose administered to cats is 1 mg
per pound (2 mg/kg) once daily. The total daily dose in cats is often 6.25 to
12.5 mg once or twice daily.
· Frequently, atenolol is given with other
drugs, especially in pets undergoing treatment for heart failure or arrhythmias
(abnormal heart rhythm). In these situations, a lower initial dose may be
prescribed.
· The duration of administration depends on the
condition being treated, response to the medication and the development of any
adverse effects. Be certain to complete the prescription unless specifically
directed by your veterinarian. Even if your pet feels better, the entire
treatment plan should be completed to prevent relapse or prevent the
development of resistance.
When enalapril is not sufficient, a second medication called
Amlodipine (Norvasc) is often tried. Amlodipine is often the first choice in
cats. This drug is in a group called calcium channel
blockers and is a standard in
human medicine. Another in this class is diltiazem (Cardizem, Dilacor,
Tiazac) It can be quite difficult or impossible to get cats to swallow
these small pills and even if they do, they may get stuck half way down to the
stomach. But they can be crushed and mixed with a paste or a liquid given
orally by syringe. These drugs have occasionally improved vision in cats with
high blood pressure. When receiving channel blockers, kidney function should be
monitored.
Another group of drugs that may help reduce blood pressure
in cats and dogs are the beta-adrenergic blockers , propranolol (Inderal) and atenolol (Tenormin). They work by
decreasing heart rate.
Diuretics such as furosemide (Lasix) and spironolactone (Aldactone,etc.) may also be employed
to decrease blood volume and in so doing, lower blood pressure as may the
vasodilator, hydralazine (Apresoline).
Parkinson’s
disease in Dogs
§
Recently, researchers have determined the cause of such disease.
Parkinson’s disease happens when there is a mutation in the Parkin protein,
which does not tag bad cells which begin to accumulate and affect the cell’s
capacity to carry out its function. Like in humans, the Parkinson’s disease in
dogs can be hereditary.
§
Scientists are continuously studying the conditions in dogs.
Specifically, they focus on determining which genes are likely to develop such
neurological conditions.
§
Parkinson’s disease can also affect younger dogs, which spells
the huge difference between the Parkinson’s disease in humans.
Parkinson’s
Disease in Dogs Symptoms
Because the muscles
play a crucial role in mobility, a dog’s ability to move around is generally
affected by Parkinson’s disease because the muscles are the target of this
illness. Hence, there will be great changes in the dog’s behavior. Symptoms of
Parkinson’s disease include:
§
Tremors in muscles. The tremors will worsen as the diseases
progresses.
§
Stiffness in muscles or stiffness in movement
§
Difficulty in balancing and in walking
§
Changes in mental alertness
§
Lethargy
There will also be
odd changes in all movements and muscle functions of dogs including their
ability to produce sounds like howl or bark. The movement disorders are
characterized by slowing down of physical movement, loss of physical movement
or akinesia, and muscle rigidity. In akinesia, it is almost always the feet
which are affected.
Parkinson’s
disease in Dogs Treatment
§
It is often hard to diagnose Parkinson’s disease in dogs and
much harder to treat because by the time the neurological disorder is
diagnosed, it is already at a later stage. In most cases, it will be too late
to try to run diagnostic tests.
§
Upon clear diagnosis of the illness, pet owners must understand
that there is a limitation to what veterinarians can offer as treatment.
§
Unfortunately, Parkinson’s disease in dogs is also incurable.
Its damages to the motor skills are irreversible.
§
The following are what the pet owners can best offer to their
dogs:
§
Restrictive diet
§
A boost in its exercise
§
Use of medications to help control the tremors
§
During the time when dogs are affected with the condition, most
pet owners seek out the advice of veterinarians for continuous treatment to
mitigate the chances of developing complications, and thus, prolong the life of
dogs.
§
In general, dogs affected with such condition, often diagnosed
at a later stage, do not have a longer life. They usually pass away while they
are sleeping.
Related Posts:
ssential tremor refers to the
uncontrollable shaking or trembling of a person's body, usually the hands and
head, but can also affect the jaw, feet, tongue and face, when they are
resisting the force of gravity. Some sufferers may have a distinctive shaky
voice when talking. Essential tremor is the most common movement disorder and
is estimated to affect nearly 10 million people in North America and Western Europe . Experts say that in over half of all essential
tremor cases, the condition is inherited.
In most cases of essential tremor, which is often referred to askinetic tremor, symptoms start in the hands and arms and then gradually spread to other parts of the body. It used to be called "benign essential tremor ", but the adjective "benign" has been dropped because it can eventually become severely disabling.
For most sufferers, essential tremor is nothing more than a slight nuisance. However, symptoms tend to be progressive - they get worse with time. In severe cases this movement disorder can be disabling, and seriously undermines the patient's ability to go about their daily activities, such as drinking a glass of water, tying things up, or writing.
We all experience minor tremor now and again when we hold, for example a cup of tea or coffee out in front of us; this is normal. Tremor is usually more noticeable as people reach old age. Essential tremor is more persistent and noticeable and tends to gradually get worse.
According to health authorities inWestern Europe , USA ,
Canada , Australia and Japan
According to Medilexicon's medical dictionary, Essential Tremor is:
In most cases of essential tremor, which is often referred to askinetic tremor, symptoms start in the hands and arms and then gradually spread to other parts of the body. It used to be called "benign essential tremor ", but the adjective "benign" has been dropped because it can eventually become severely disabling.
For most sufferers, essential tremor is nothing more than a slight nuisance. However, symptoms tend to be progressive - they get worse with time. In severe cases this movement disorder can be disabling, and seriously undermines the patient's ability to go about their daily activities, such as drinking a glass of water, tying things up, or writing.
We all experience minor tremor now and again when we hold, for example a cup of tea or coffee out in front of us; this is normal. Tremor is usually more noticeable as people reach old age. Essential tremor is more persistent and noticeable and tends to gradually get worse.
According to health authorities in
According to Medilexicon's medical dictionary, Essential Tremor is:
"An
action tremor of 4-8 Hz frequency that usually begins in early adult life and
is limited to the upper limbs and head; called familial when it appears in
several family members."
What are the signs and
symptoms of essential tremor?
A symptom is something only the patient feels
and has to describe to the doctor, such as pain, dizziness, nightmares or
discomfort, while a sign is something others can detect, such
as a rash, swelling or fever.
There is only one main symptom of essential tremor - trembling. In the majority of cases, the hands tremble in an up-and-down movement.
Tremor may affect the following parts of the human body:
There is only one main symptom of essential tremor - trembling. In the majority of cases, the hands tremble in an up-and-down movement.
Tremor may affect the following parts of the human body:
§
Eyelids
§
Face
§
Feet (rare)
§
Hands (and arms)
§
Head
§
Jaw
§
Larynx (voicebox)
§
Legs rare)
§
Tongue
Signs and symptoms tend to start later on in life. The
earlier in life they begin, the worse the condition tends to be and become.
When the body part that is usually affected is at rest, there are no symptoms. The condition seems to be more noticeable when it is applying a force against gravity.
For most patients, both sides of the body are affected equally. The problems tend to become particularly noticeable when the patient tries to write, hold out a drink (especially with an outstretched arm), do some sewing or knitting, or any other task that requires dexterity.
Signs and symptoms tend to worsen when the patient:
When the body part that is usually affected is at rest, there are no symptoms. The condition seems to be more noticeable when it is applying a force against gravity.
For most patients, both sides of the body are affected equally. The problems tend to become particularly noticeable when the patient tries to write, hold out a drink (especially with an outstretched arm), do some sewing or knitting, or any other task that requires dexterity.
Signs and symptoms tend to worsen when the patient:
§
Has consumed large amounts of caffeine
§
Is anxious
§
Is doing something strenuous
§
Is on certain medications
§
Is stressed
§
Is upset
Although symptoms tend to be mild in most cases, the
condition becomes progressively worse over time.
What are the causes of
essential tremor?
Research has shown that the ETM1 gene, also known as FET1,
which exists in chromosome 3, as well as ETM2 which is located in chromosome 2,
are linked to a higher risk of developing essential tremor. As two genetic
variations on different chromosomes have so far been identified, the condition
is probably associated with various genes.
Scientists at the Universite Laval, Canada, noticed a drop in GABA receptor concentrations in the cerebellum of patients with essential tremor. GABA receptors pass chemical messages which transmit inhibitory data to various parts of the brain. The researchers believe that a decrease in GABA receptors in the cerebellum may contribute to essential tremor symptoms.
Experts believe the gene mutation has an impact on the cerebellum and the inferior olive (brain areas), altering the way signals are sent from the brain, down the nerves to the muscles.
Approximately half of all essential tremor cases are thought to be inherited. Nobody knows why patients with this condition who have no family history or genetic mutation become affected.
There is no test available today to determine whether a patient's essential tremor is caused by a specific gene.
Triggers - some people find that specific actions may bring on their symptoms. Examples include:
Scientists at the Universite Laval, Canada, noticed a drop in GABA receptor concentrations in the cerebellum of patients with essential tremor. GABA receptors pass chemical messages which transmit inhibitory data to various parts of the brain. The researchers believe that a decrease in GABA receptors in the cerebellum may contribute to essential tremor symptoms.
Experts believe the gene mutation has an impact on the cerebellum and the inferior olive (brain areas), altering the way signals are sent from the brain, down the nerves to the muscles.
Approximately half of all essential tremor cases are thought to be inherited. Nobody knows why patients with this condition who have no family history or genetic mutation become affected.
There is no test available today to determine whether a patient's essential tremor is caused by a specific gene.
Triggers - some people find that specific actions may bring on their symptoms. Examples include:
§
Applying make-up
§
Drinking a glass of water
§
Eating
§
Shaving
§
Writing
§
Some people find that their symptoms are worse if they are tired
or did not get enough sleep
§
Long-term daily consumption of at least three units of alcohol per
day raises essential tremor risk, a 2009 study found.
Several illnesses and conditions are associated with
"normal" tremor, such as hyperthyroidism (overactive
thyroid),Parkinson's disease,
peripheral neuropathy, stroke, dystonia,
MS (multiple sclerosis),
alcohol withdrawal, illegal drug abuse, and some medications.
How is essential tremor
diagnosed?
There is no "essential tremor test". Therefore,
doctors will go through a process of elimination, ruling out possible illnesses
and conditions, determining whether there is a family history, as well as
carrying out a physical exam. The doctor will also check what medications the
patient is on, in case the tremors are linked to them.
The following diagnostic tests may be ordered:
The following diagnostic tests may be ordered:
§
A CT
§
An MRI (magnetic resonance imaging) scan of
the brain
§
An EMG (electromyography) test, to determine the electrical
activity of the muscles. This test can help the doctor see whether there is any
nerve damage.
§
Blood tests
§
Urine tests
The patient may be asked to drink from a glass, hold
his/her hands outstretched, write, or draw a spiral to evaluate the tremor
itself. The doctor will also examine the patient's muscle strength and tone,
tendon reflexes, gait, posture and coordination, and the ability to feel
specific sensations.
What are the treatment
options for essential tremor?
If the patient's symptoms are mild, the doctor may advise
no treatment. However, if the individual's quality of life and ability to carry
out everyday tasks are affected, treatment will be recommended.
The following medications have been found to help with essential tremor symptoms:
The following medications have been found to help with essential tremor symptoms:
§
Beta blockers - designed to treat
hypertension (high blood pressure), these drugs may help,
especially those who take medications for asthma, diabetes or
certain heart conditions. Examples include propranolol, atenolol, nadolol, and
metoprolol.
§
Anticonvulsants (epilepsy medications) - may be prescribed if the patient did not experience symptom-relief
from beta blockers. Examples include primidone,
topiramate, and gabapentin.
§
Sedatives - these medications
may be prescribed if the tremors are triggered by tension or anxiety and
the above medications did not work. Examples include Valium (diazepam) and
Xanax (alprazolam).
§
Botox (OnabotulinumtoxinA) injections - especially if the head and/or voice are affected.
Treatment is usually effective for about three months. Experts say that Botox should
not be used to treat hand tremors because the muscles in the area may become
weaker.
Sometimes essential tremor symptoms may be so severe that
surgery is recommended (rarely). The following surgical procedures are
possible:
§
Deep brain stimulation - electrodes are placed in the thalamus, in the brain.
Fine needles go through tiny holes in the skull. The whole procedure is done
with a general anesthetic. Thin wires connect the electrodes to a pulsegenerator
device which is implanted under the skin in the chest. The generator helps
regulate brainwaves and control tremor by sending electric currents.
Health authorities in theUnited
Kingdom
Side effects are very rare, but may include fluid in the brain, infection of the surgical scar, tingling, and bleeding in the brain. Stroke is also a possible (very rare) risk.
77% of essential tremor patients who underwent deep brain stimulation no longer needed to take any medications 12 months after the procedure, researchers from theUniversity of South Florida reported at the annual meeting of the American Academy
of Neurology in Honolulu , Hawaii
Health authorities in the
Side effects are very rare, but may include fluid in the brain, infection of the surgical scar, tingling, and bleeding in the brain. Stroke is also a possible (very rare) risk.
77% of essential tremor patients who underwent deep brain stimulation no longer needed to take any medications 12 months after the procedure, researchers from the
§
Thalamotomy - a small hole is made
in an area of the brain called the thalamus.
The thalamus (red) is the target part of the brain in deep brain stimulation and thalamotomy
The thalamus (red) is the target part of the brain in deep brain stimulation and thalamotomy
Deep brain stimulation is said to have fewer side effects
than Thalamotomy.
Physical therapy (UK
Occupational therapy - this involves seeing an Occupational Therapist, who may recommend some adaptations to make daily activities easier, such as:
Physical therapy (
Occupational therapy - this involves seeing an Occupational Therapist, who may recommend some adaptations to make daily activities easier, such as:
§
Having heavier cups, glasses, plates and utensils
§
Using thick pens and pencils for writing
§
Using wrist weights
What Are The Treatment Options For Parkinson’s
Disease?
There is currently (April, 2010) no cure for
Parkinson’s disease. Therapy focuses on treating the symptoms that undermine
the patient’s quality of life. As people have enormously varying symptoms and
levels of severity, there is no standard or best treatment that applies to
everybody.
Treatment approaches include medication, surgery, general lifestyle modifications (rest and exercise), physical therapy (UK
Treatment approaches include medication, surgery, general lifestyle modifications (rest and exercise), physical therapy (
Medication
Medication - as most Parkinson’s symptoms are caused by low levels of
dopamine in the brain, most drugs are aimed at either replenishing dopamine
levels, or mimicking its action - dopaminergic drugs do this. Dopaminergic
medications reduce rigidity (muscle stiffness), improve speed, help with
coordination, and lessen tremor (shaking). Taking dopamine itself does not
help, because it cannot enter the brain.
§
Levodopa - the most effective Parkinson’s drug; is absorbed by the
nerve cells in the brain and turned into dopamine. It is taken orally, in
tablet or liquid form. Levodopa is combined with carbidopa to create Sinemet, a
combination drug. Carbidopa prevents the levodopa from being destroyed by
enzymes in the digestive tract; it also reduces levodopa side effects, such as
nausea, vomiting, fatigue and dizziness. In the UK
and the rest of Europe benserazide may be combined
with levodopa (Madopar).
As Parkinson’s disease progresses the effects of levodopa may wear off and the doctor may have to increase the dosage. Increased dosage also raises the risk of developing side effects, which may include confusion, delusions, hallucinations, compulsive behavior, and dyskinesia (involuntary movements). Reducing the dosage will usually help with side effects, but with the risk that parkinsonism increases.
As Parkinson’s disease progresses the effects of levodopa may wear off and the doctor may have to increase the dosage. Increased dosage also raises the risk of developing side effects, which may include confusion, delusions, hallucinations, compulsive behavior, and dyskinesia (involuntary movements). Reducing the dosage will usually help with side effects, but with the risk that parkinsonism increases.
§
Dopamine agonists - these drugs mimic the effects of dopamine in the brain.
The neurons react as they would to dopamine. Although not as effective as
levodopa, dopamine agonists last longer and help reduce the waning effect of
levodopa. They are usually prescribed in tablet form, but may also be taken by
injection, or as a skin-patch. Examples include pramipexole (Mirapex),
ropinirole (Requip), rotigotine (Neupro), and apomorphine (Apokyn).
Side effects are similar to those of carbidopa-levodopa. The risk of developing compulsive behaviors, such as compulsive gambling and hypersexuality are greater.
Side effects are similar to those of carbidopa-levodopa. The risk of developing compulsive behaviors, such as compulsive gambling and hypersexuality are greater.
§
Monoamine oxidase-B inhibitors (MAO B inhibitors) - an alternative to levodopa. Examples
include selegiline and rasagiline. MAO B inhibitors work by blocking the
effects of monoamine oxidase-B (MAO B) in the brain. Monoamine oxidase-B
destroys dopamine - by blocking MAO B the dopamine can last longer in the
brain. MAO B inhibitors have a smaller effect than levodopa. MAO B inhibitors
can be used in combination with levodopa or dopamine agonists. There is a risk
of serious interactions with some medications used for treating depression, as
well as some narcotics.
Side effects of selegiline may include:
Side effects of selegiline may include:
§
Dizziness
§
Dry mouth
§
Headaches
§
Nausea
§
Stomach pain
§
Strange and/or vivid dreams
Side effects of rasagiline may include:
§
Conjunctivitis
§
Dizziness
§
Fever, with joint and muscle aches (flu-like)
§
Headache
§
Indigestion
§
Neck pain
§
Runny nose
§
Stomach pain
Muscle twitching
(painless), Shaking hands or tremor and Weakness
WebMD Symptom Checker helps you find the most common medical
conditions indicated by the symptoms muscle twitching (painless), shaking hands
or tremor and weakness including Benign essential tremor, Parkinson disease,
and Hypocalcemia.
There are 11 conditions associated with muscle twitching
(painless), shaking hands or tremor and weakness. The links below will provide
you with more detailed information on these medical conditions from the WebMD
Symptom Checker and help provide a better understanding of causes and treatment
of these related conditions.
Benign essential tremor can cause shaking of the
hands and forearms and a quivering voice.
Parkinson's disease is a disorder of the nervous
system causing tremors stiffness and slow movement.
Hypocalcemia is a blood condition marked by
tingling, muscle spasms and aches, and confusion.
Peripheral neuropathy is a nerve condition of
the extremities causing numbness, tingling, and pain.
Tendinitis symptoms include muscle and tendon
pain or stiffness close to a joint, and pain with movement.
Low blood sugar, or low glucose levels, causes
shakiness, anxiety, clammy skin, irritability, hunger, and more.
Multiple sclerosis is a disease of the nervous
system causing difficulties with balance, speech, and movement.
Cervical spinal stenosis is a spinal condition
causing pain, weakness, or numbness in the arms, legs, or neck.
Amyotrophic lateral sclerosis affects the
nervous system and causes muscle weakness and brain dysfunction.
A brachial plexus injury involves the nerves of
the neck and shoulder and causes tingling, numbness and more.
Exercise is vital for good health, but overdoing
it can lead to muscle aches, dehydration, headache, and m
