Abdominal Spasms and change in meds

[pamhb]

I am wondering whether anyone else is having trouble with muscles spasms which originate in the abdomen, and then spread to the torso and legs?

I have had WED/PLMS for a very long time, and just went through a meds change from a combination of clonazapam and pramipexole to a combination of gabapentin and ropinerole. The transition was very difficult -- when I was undermedicated, I was spasming continuously throughout my body, but with the spasms originating in my abdomen. My doctor put me back on clonazapam to control the spasms, until my medications were up to a reasonable dosage.

We eventually got my medications stabilized to a point where I was symptom free. That was four weeks ago. This past week I have had some breakthrough spasming. Most often it is just my left leg, with the classic PLMS symptoms. Last night, however, it was again a full body spasm starting in the abdomen. If I try and meditate during the afternoon, the twitching will also start up. The full body spasms concern me the most. I wonder if this is part of my disease, or whether something else is going on. (I'm waiting to see a neurologist). If it's part of my disease, I'm wondering what other meds people are finding effective.

I am also starting to suspect a connection between the intensity of my spasms, and my exercise program. I am working with a physiotherapist to strengthen a number of muscles because of hip issues. It seems to be that as the intensity of the exercises increase, so do my spasms. I work long and hard each evening to try and work the knots out of my muscles and get them to relax. If I'm successful, I'll be able to sleep. If not, I'll be twitching.

Any thoughts, experiences, or drug advice to share?

[Rustsmith]

I can't be sure that we are talking about the same thing, but the worst part of my untreated WED could either be described as a spasm or a need in my abdominal muscles to clench up into a small ball. This would then spread to my arms and legs so that I would end up curled into a very tight ball. Initially, my treatment was with pramipexole and this resolved the spasms until I augmented. I am now on rotigatine and gabapentin and only experience problems with my abdominal muscles during the most severe breakthroughs. During these current day breakthroughs, a very hot shower has worked wonders for me.

[pamhb]

Yes, I think that's very close to what I experience -- it starts in my abdomen, and if I'm lying down, draws my upper torso forward and down, and my legs forward and up, so that I end up in a type of fetal position. It then loosens and the starts again.

Hot shows and baths help a bit, but not enough, I'm afraid... But it is very comforting to know I'm not alone! Do you have any idea as to what triggers your breakthroughs?

[Rustsmith]

I do not have any good ideas of what triggers my problems. I believe that there is a correlation with the local pollen counts, partly because my respiratory allergies are just as severe as my WED. My doctor doesn't seem to have any ideas other than to blame them on the second generation antihistamine that I have been taking every day for over a decade. My suspicion is that there is a linkage but have not been able to figure it out for myself just yet. I have therefore stopped taking the antihistamine on the doctor's advice and will wait to see.

As for the triggers that everyone else talks about - exercise, caffeine, sugar, chocolate, alcohol, ..., none of them seem to have any effect on my WED/insomnia issues.

[pamhb]

Apparently antihistamines interfere with the dopamine receptors, which is why they can make WED worse. I have allergies as well, so have been trying various ones out the past couple of days. Aerius seemed to have the least effect on my legs -- but like you, I've given them up entirely. I as well haven't noticed that the usual suspects (caffeine, alcohol, chocolate) make a spit of difference when I'm curled up in a ball spasming. Maybe if I had mild WED I'd notice a difference.

I am currently interested in learning more about neuroplasticity, and whether we can train our brains to stop the spasms. They are having good results with Parkinson's Disease and exercise, particularly where the patient is forced to used mental activity while performing the activity (dancing, tai chi, wii) -- but the more vigorous the activity, the better. MS also uses exercise to reduce spasms, particularly elliptical trainers and bike riding.

I have also stumbled across the theories regarding plyometric training in relation to muscle cramping/spasms. Here is an excerpt from a much longer NIH article:

"A common perception is that level of conditioning is a factor in the development of EAMC. There is a strong theoretical basis for performing exercises that target the neuromuscular system to prevent EAMC. Prevention exercises that target muscle spindle and GTO receptors should be implemented to delay neuromuscular fatigue onset and, hence, EAMC. Plyometric exercises may be beneficial to elicit neural adaptations in muscle spindle and GTO receptor firing, enhancing efficiency and sensitivity of reflexive and descending pathways used for neuromuscular control. Endurance training may also serve as an effective means of preventing EAMC by expanding plasma volume and the extracellular fluid compartment and delaying neuromuscular fatigue. (EAMC stands for Exercise Associated Muscle Cramps).

I have noticed that my spasms are more likely to break through when I have done more vigorous lower body strength training, making my muscles very tight and knotted. This morning, after an awful night of breakthrough spasms, I tried some very simple plyometric exercises, and it seemed to help calm things down. It's something I'm going to discuss further with my physiotherapist.

I think the whole field of neuroplasticity offers WED sufferers more hope than we have had in years. But it requires research into exactly which types of training exercises will give the desired result - and that means having a better understanding of the mechanisms of the disease.

[ViewsAskew]

Fascinating...not the spasms! But, the research into neuroplasticity. Huh.

[Rustsmith]

Supposedly the second generation antihistamines (Claritin, Allegra and Zyrtec) are larger molecules that do not cross the blood-brain barrier. This is why they are marketed as non-sedating, unlike Benadryl. From what I have read, there are some questions about the possibility that a small amount of Zyrtec leaks across the barrier. Unfortunately for me, Claritin is not strong enough for me and Allegra prevents me from being able to sleep for at least 24 hrs.

As for neuroplasticity, it is something that I get to witness on a daily basis. My wife has had MS for over 45 years. She had one of her neurologists tell her that there was such a large portion of her brain that was no longer functional due to scarring that it was amazing that she was even alive, much less able to walk (sort of) and live life with a semblance of normality. She is able to do this because neuroplasticity has allowed her to slowly rewire connections over the years to areas that have not been affected by the lesions. As for plyometrics, she has a routine that she does for about an hour each week in the pool. There are issues with MS where getting overheated is a trigger, so many MS patients benefit from exercise in the pool where you are continually cooled, even while doing a strenuous workout. There are also special yoga classes for MS patients, which would also qualify for this sort of consideration.

[pamhb]

Dystonia is another muscular/neurological disorder characterized by involuntary muscle contractions that cause slow repetitive movements or abnormal postures. For an interesting video on how the theories of neuroplasticity changed one man's life, see the video in this news article.

http://www.theglobeandmail.com/life/hea ... e23342494/