Suggest Remedy For Rigidity On Hand After Use Of Clonozepam

Posted on Sat, 31 Jan 2015

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Sat, 31 Jan 2015 Answered on

Sat, 28 Feb 2015 Last reviewed on

Question : Hi Sir,

My mother in law(aged around 58) suffering from PD from last 3-4 years. Her left hand is very rigid from last 1.5 yrs., it can’t work like right hand. She took synodapa+ for an year but no use.
We took her to NIMHANS XXXXXXX they admitted and and after 3-4 days of observation they felt that its hemidistonia and hence advised to use leofin,clonazepam,pacitene tables. She used them for 1 month and said feeling very lazy and dull. So we stooped medicine based on her request but doctor told to again use, we are continuing them but no use. Day to day her position is getting worst. Sometimes she says I want to die.

During admission in NIMHANS they have given 3 Botox injections to left hand but no use.

We are staying in XXXXXXX After googling I found ur name as good PD doctor. Could you please suggest our next steps?
Do you have any recommended doctor’s in XXXXXXX for the same. Coming to XXXXXXX is very difficult because I have kids and job in XXXXXXX Managing office and her will be challenging if we come to XXXXXXX
So iam looking for best options/advises from you.

Kindly please suggest the way forward.

Thanks in advance sir.

Regards,
XXXX
0000

Answered by Dr. Sudhir Kumar (9 hours later)

Brief Answer:
Your mother-in-law needs detailed evaluation.

Detailed Answer:
Hi,

Thank you for posting your query.

I have noted your mother-in-law's symptoms and treatment done so far.

I agree that we need to be sure of her diagnosis, before we decide the best course of medications/treatment for her.

Clinical examination is the most important in differentiating Parkinson's disease (PD) and hemidystonia.

In PD, tremors or shivering is the main symptom. Slowness and rigidity are other symptoms. Patients with PD respond well to Syndopa treatment.

On the other hand, in dystonia, the main symptom is rigidity. Tremors are absent. Also, there is inadequate relief with syndopa.

In mainly one-sided rigidity of hand, we also need to consider a diagnosis of cortico-basal-ganglionic degeneration (CBGD).

After neurological examination, PET-CT scan of brain may be done to confirm the diagnosis.

Once the diagnosis is confirmed, a proper treatment plan may be made.

At XXXXXXX good PD doctors include Dr XXXXXXX Muthane and Dr XXXXXXX Kumar Pal.

I hope my reply has helped you.

I would be pleased to answer, if you have any follow up queries or if you require any further information.

Best wishes,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX
For DIRECT QUERY to me: http://bit.ly/Dr-Sudhir-kumar
My blog: http://bestneurodoctor.blogspot.com/

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (26 hours later)

Thank you sir for ur valuable suggestions.tremers are not there but when she tried to lift or handle then only shaking happens.

When ever she thinks more she need support for walking aswell.

In case if its required DBS will help to resolve this issue? Any side effects of DBS if done at this age?

Thanks,
XXXX

Answered by Dr. Sudhir Kumar (1 hour later)

Brief Answer:
DBS has specific indications.

Detailed Answer:
Thank you for getting back.

First of all, Deep brain stimulation (DBS) has specific indications and can not be done in all situations. In PD, DVS helps those who have predominant tremors as the main symptoms. The second group of patients that benefit from are those with dyskinesias (involuntary movements related to syndopa use).

DBS is generally safe and there are no major side effects, if done in experienced enters.

Best wishes,

Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar