Movement disorders program atlantic neuroscience institute

As well, environmental factors can be attributed, including medications, toxins, infections, or stroke. Spinal cord injury, head, and peripheral injury are also recognized contributors to dystonia. Spasticity is when patients experience stiff, often painful limbs due to excessive muscle contractions. Causes include multiple sclerosis, stroke, tumor, and cerebral palsy. Botulinum toxin Botox, Xeomin, Dysport, Myobloc can help improve range of motion.

Tremors are most commonly noticed in the hands and arms, but may affect other body parts, including the neck. Botulinum toxin can be very effective in treating tremors. Saw Dr. Restless legs syndrome RLS is a common condition that can disrupt sleep. While it can be treated with a variety of medications, dopaminergic drugs, including dopamine agonists and levodopa, appear to be the most reliable in alleviating symptoms.

Unfortunately, however, long-term treatment with dopaminergics can lead to the problematic complication of augmentation [ 1 , 2 ]. Augmentation is a phenomenon in which the medication leads to a worsening of symptoms beyond the level of severity that was experienced when the medication was first given [ 1 , 2 ]. During augmentation, patients may experience an earlier onset of night time symptoms, more severe symptoms, the onset of day time symptoms and a declining response to the drug, requiring higher and higher doses.

While most authorities recommend removing the offending drug [ 1 , 3 , 4 ], the best approach for accomplishing this or substituting for the drug has not been established. In a previous study, we found that sudden withdrawal of the dopaminergic medication with substitution of a medication from a different drug class antiepileptics, benzodiazepines, analgesics was generally poorly tolerated, resulting in a major worsening of symptoms and a long delay of many months before symptoms stabilized [ 5 ].

Because of that experience, we tested an alternative approach of very slowly tapering the dopaminergic drug while at the same time administering an alternative medication.

We conducted a retrospective chart review of RLS patients who presented to the Movement Disorders Program at the Atlantic Neuroscience Institute between and with dopaminergic drug-induced augmentation. We selected those patients who had the dose of their dopaminergic medication gradually tapered and stopped when possible and simultaneously treated with an alternative medication.

We focused on the period of time from the recognition of augmentation to the stabilization of RLS symptoms. Findings were compared to our previous published experience with sudden dopaminergic drug withdrawal [ 5 ].

We identified 7 RLS patients who presented with dopaminergic drug-induced augmentation and were treated with this approach. There were five females and two males with a mean age of The mean time since diagnosis of RLS was 18 range 3.

At the time of appearance of augmentation, there were four patients taking regular or extended length ropinirole with a mean dose of 2. All of these medications had been taken at bedtime. The mean duration of dopaminergic drug therapy until the diagnosis of augmentation was 6. The treatment strategy for each patient was similar. Each began a gradual tapering schedule of their dopaminergic drug with the aim of trying to discontinue it over months.

All of the patients were given written tapering schedules to follow, decreasing the dose of their dopaminergic medication on a weekly or biweekly basis. At the same time, each patient was started on another RLS-suppressing drug. In one case, clonazepam was the replacement drug 0. Of the 7 patients who began to wean off of the dopamine medication, 4 were able to stop the medication mean time for discontinuation of 4. The mean time to resolution of augmentation was Three of the patients have not yet been able to complete their tapering of the dopaminergic drug and eliminate it due to recurrences of augmentation symptoms.

At this time, mean duration of tapering is 32 range weeks. One patient required the addition of tramadol The success of the gradual tapering for all of the patients varied greatly. For these patients, the most difficult stage has been stopping the drug from a small dosage. One patient was able to wean from 3. Another patient, who began at a dose of 1. Share: Print Email Facebook Twitter.

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