Caught me with my references misplaced, and it's too late and I'm too
tired to figure out where they are (had brought home a file of some of
my papers overy the past several years, for just such emergencies!)
HOWEVER (pending my posting exact citations): my paper at the Society
for Neuroscience (November. in LA) cited and used as a model a paradigm
using an animal model of Parkinsonism--6-OH-dopamine lesions
compensated for until basal ganglia compensation overcome by huge
demand due to stress (several kinds of stress used), wheupon motoric
deficits emerged. Abigail Snyder and--??, in Neurology, c. 1986.
Update: Zalcman et al. (n.b. long ago, he participated in this
newsgroup, gave up in disgust, I guess) showed that IL-1 acted like a
stressor in prefrontal-accumbens-caudate region, even at levels not
sufficient to engage HPA axis and elevate plasma cortisol.
Conceivably, with a pre-existing vulnerability, infection (causing
increased production of IL-1) could elicit latent basal ganglia
disorders.
SUBSEQUENTLY, I had the good experience to hear (Susan?) Swedo at the
Assoc for Res in Nerv & Ment Dis annual meeting (NYC, December): after
original illness, recurring challenges (strep throat?) caused
exacerbation of OCD and/or Tourette's thype symptoms.
Sorry for vagueness. Will try to get exact citations later.
(If you FAX request to me at work, might help: 914-786-4978)
F. Frank LeFever, Ph.D.
New York Neuropsychology Group
In <76ppvh$9g6$1 at camel0.mindspring.com> "Gavin Roberts"
<mgroberts at mindspring.com> writes:
>>I am a 30 year old male in relatively good physical shape. I have had
no
>previous health problems to speak of except some minor sinusitis.
This
>March 1998 I contracted Hepatitis A from a workplace cafeteria and did
not
>recover until the Middle of April. This was the first major ailment
>(barring childhood Mono, Chicken Pox, flu, etc.) that I had contracted
>during my life. Upon recovery I felt almost completely normal,
returning to
>my normal eating and work-out routines. I gained back the weight I
had lost
>(to 165 lbs) and quit drinking Alcohol altogether. I have never
smoked.
>>On December 3, 1998 I noticed some difficulty typing on my PC. My
thumbs
>were shaking slightly and my hands were stiff and sore. At first I
thought
>it was probably just due to the large amount of work I had been doing
>lately, but then I noticed some shakiness in my shoulders, arms, and
legs
>when I moved or lifted anything. I also noticed a slight resting
tremor in
>both thumbs and later in other fingers on both hands. The Cogwheel
>shakiness was most noticeable in my shoulders when I moved or shrugged
them
>and in certain neck movements. Lifting my legs also precipitated some
>shakiness and non-smooth muscle contractions.
>>On December 5 I went to the gym and noticed slight shakiness, but
overall
>had normal stamina and strength. I had no signs of an infection of any
kind
>before these symptoms presented themselves. The only possible sign of
an
>infection was a slight sore throat the weekend before.
>>The following are the symptoms that were first observed (starting Dec.
3)
>>ï· Tension in neck, shoulders and legs, accompanied by shaky,
cogwheel muscle
>movement. The shakiness and tension reminded me of what happens after
>drinking lots of coffee and feeling tense and shaky. This tension
âwiredâ
>me and I felt on edge and restless.
>ï· Fatigue and stiffness in hands. Typing became difficult and hand
strength
>seemed diminished. Hands become swollen after too much activity.
>ï· Slight twitching in lips
>ï· âShiveringâ spells where my body would shiver with much more
vigorous
>muscle contractions than normal (mostly in legs, torso and arms).
These
>episodes were usually triggered by a small chill, but some were
spontaneous
>(e.g. in bed while sleeping, nerves would come alive and muscles would
start
>to shiver). I was able to calm these episodes by warming up and
taking
>deep breaths to calm down.
>ï· Sporadic muscle spasms
>ï· Slight dizziness
>ï· Facial tension
>ï· Tingling in hands and feet, especially after working with my
hands, or
>after sleeping
>ï· Overall anxiety due to mysterious symptoms
>>I scheduled an appointment with my Primary Care Doctor 7 days later
(Dec 11)
>and he performed a standard reflex/neurological exam on me accompanied
by
>CBC, ANA, CPK and SED rate blood screens. All turned out normal
except the
>CPK test which was elevated to 411 (normal range is 38 â 174). My
weight
>had also dropped about 10 lbs below my normal (from 165 to ~155 lbs).
>>On Dec 21 I was refered to a neurologist who performed another
neurological
>exam on me with no alarming reflex/neurologic findings. I
demonstrated the
>cogwheel shakiness in my hands arms and shoulders and mentioned my
tense,
>âwiredâ symptoms. He ordered tests for Thyroid, Parathyroid and
>Hypocalcemia conditions, but all of these conditions were ruled out
after
>thyroid hormone, parathyroid hormone, magnesium, phosphorus and
calcium
>levels were all confirmed normal. My CPK was also re-drawn and
determined
>to be 214 â lower than the previous 411, but still slightly
elevated. My
>weight dropped to 150; 15 lbs below my normal weight of 165. He also
>performed a nerve conduction study to see if my hand fatigue was
related to
>carpel tunnel. These studies showed very good nerve conduction.
>>On Dec 23, I worked out again (per OK from neurologist), hoping to
increase
>muscle mass and regain some weight. During this workout I noticed a
>significant reduction in strength with much more shakiness and the
need to
>take more rests throughout. Immediately afterwards, I noticed that my
thumb
>and index fingers were twitching quite vigorously. I bought some
weight
>gain powder to try and augment my diet with additional calories and
Protein.
>>The day after my workout (Christmas Eve), I was completely exhausted
and
>weak. I found it uncomfortable to stay standing for any length of
time and
>had to lay down often to regain energy. This weakness was primarily
felt in
>the legs, but was also felt greatly in my hands and arms as well. The
>weakness continued for about 5 days with little improvement. It
seemed that
>every muscle group that I had worked on December 24, was greatly
weakened
>with no evidence of muscle re-building. I also started experiencing
more
>light headedness and what felt like slight pressure or tension on my
>forehead, temples, behind the ears and the back of my head and neck.
I also
>had some slight nausea. With these symptoms, an MRI was ordered
(Head,
>Neck and Cervical Spine), but the results showed no abnormal tumors,
lesions
>or Myelin breakdown evidence. A Third CPK blood screen was also
performed
>(Dec. 29) and was recorded at 107, which was within normal limits. A
lyme
>disease test also came back negative.
>>In addition to the weakness, It was also more difficult to chew food
(jaw
>seemed to tire easily), and I had some facial fatigue that felt like I
had
>been smiling for hours. The wired, tense feeling and shivering
episodes
>seemed to subside with the onset of the weakness, however the cogwheel
>shakiness of all limbs continued just as it had done for the 3 weeks
before.
>I concentrated on maintaining my weight and have so far been
successful at
>maintaining my weight at 150 lbs for the last week.
>>As of today (January 2, 1999) I have regained a small amount of
strength,
>but my legs are still very weak. I am afraid to work any part of my
body
>for fear of weakening myself any further. I am even refraining from
doing
>any hand strengthening exercises for fear of further damaging my
hands.
>Head and facial tension/fatigue seems to have subsided, but the
cogwheel
>shakiness seems more prevalent than ever. Overall neck and leg
tension (and
>semi-wired feeling) seems to be slowly coming back. My hands continue
to be
>very weak and fatigued. My primary care doctor and neurologist are
both
>stumped and the next step is a CT Scan of my abdomen to make sure that
I don
>ât have any Adrenal Gland abnormalities or any other surprises. The
>following diseases have evidently been ruled out.
>>ï· Meningitis â Per neurological exam - No Brudzinkiâs sign or
Kernigâs sign
>ï· Myelitis â Per neurological exam
>ï· Encephalitis â No fever or brain inflammation
>ï· Brain Tumor/Spinal Cord Neoplasm â Per MRI results
>ï· MS â Per MRI results
>ï· Peripheral Neuritis â Deep tendon reflexes in tact
>ï· ALS (Lou Gehrigâs disease) â Per neurological exam and lack of
>fasciculations
>ï· Guillain-Barreâ â Per neurological exam â reflexes in tact
>ï· Myasthenia Gravis â Per neurological exam (? Not sure)
>ï· Wilsonâs disease â no Kayser-Fleischer ring
>>My question is whether there is any explicable answer to these
conditions
>and what the probability that these symptoms are from a viral
infection
>which would not present itself in any standard way (e.g. fever,
respiratory
>infection, etc.)? Could this be a non-neurological condition possibly
from
>another chemical or hormonal imbalance? Due to the rapid onset of
symptoms
>I have also considered Heavy Metal Poisoning and or other poisoning as
a
>possibility, but have no idea where I might have been exposed to high
levels
>of such toxins. I am also wondering if these symptoms might represent
the
>onset of a rare variant of Parkinsonâs disease which may strike
younger
>adults (note that Wilsonâs disease is probably not it).
>>Any help with this or relation to any similar symptoms would be
greatly
>appreciated!
>>>>