Medication question-Trihexyphenidyl
 

I recently posted about my 26 year old brother who had sudden onset of severe tremors and shaking. They went thru all of the tests and determined nothing chemical or seizure related. He does have a tiny arachnoid cyst according to the 1st doctor. He started taking benadryl with her recommendation with no response what-so-ever.

One week later he had occasions of not being able to walk, lasting up to 2 hours and stuttering that made him absolutely non-understandable. 4-5 trys to get out each word.

He went to another family doctor who pulled the MRI and read that there is a prominent CSF space in the midline in the posterior fossa and measures 31mm x 37mm x 47mm, this doesnt sound tiny to me. It also said a 8 mm frontal subcortical white matter, may represent gliosis or demyelination. He is going to a neurosurgeon hopefully Monday or Tuesday.

My question is with the medication Artran (Trihexyphenidyl), that the doctor started him on yesterday. Within about 3 hours we were able to understand him and his shaking was notablely decreased. We have not counted out the fact that the cyst is not causing anything (like several doctors have said )and his symptoms are related to stress and anxiety (of course increased at this point from worrying).

I guess it comes down to is this a medication that can have immediate effect? Or could it be working like a placebo for him?

Thanks for your help and suggestions.
Michelle

Trihexyphenidyl
 

Hi Michele,
I have been taking trihexyphenidyl for nearly a year now, on the advice of my new neuro. It was prescribed to combat rigidity in my joints.
I find it seems to have little effect, I notice no difference if I don't take it. I have not noticed any side effects.
Your brother's symptoms don't seem to be typical for Parkinson's disease. It took 10 years of PD before I had difficulty in walking, (I have had PD for 16 years.). Difficulty in walking takes years, not overnight. PD is generally a slow developing disease,
It looks more like your brother is undergoing a breakdown of sorts, and is extremely stressed. A sudden onset of severe tremors and shaking is not PD, and I feel sure it is not due to the trihexyphenidyl.
What is worrying him at present, has he undergone some recent trauma? If you can remove the thing that seems to be causing the stress, he should improve. Is he going through any emotional or financial worries at present?
Sorry I can't help topo much, but keep us posted.
Hre is lucky to have you to look after him.
Best wishes
Ron

MMPI test
 

as I mentioned in your other thread, I'd get him tested for depression. If he has not already had one, I'd get him tested for heavy metals poisoning also. This involves collecting all his urine for 24 hours. There is a good movement disorder clinic at the University of Philadelphia I think. They will be able to assess his condition.

Charlie

It could be an episode of Multiple Sclerosis, which causes demyelination. It can be difficult to diagnose and many patients were only diagnosed after seeing a specialist is MS.

I take low dose artane, and it does help me... with dystonia, intention tremor, and my gait.

A general neurologist may be your best bet at this stage, and if the neuro does not try to rule out (or in) MS with various tests, I'd see an MS specialist.

MS episodes can come on VERY suddenly and be very disabling. The patient may eventually recover, or remain disabled. Every one is unique.

~Zucchini

Thanks All

He has not had any noticable increased stress or unusual situations. We have not discounted the fact that it may be stress related. He is very reluctant to see a psych doctor so we have done so searching for a younger male neurologist/neurosurgeon that my coworkers think he may relate to better. Bedside manner and presentation go along way in trusting what a doctor has to say. His exact words were something like "I know I am not crazy", he is that type of person, and the more you suggest, the more defensive he gets. That tells me something right there.

He should have an appointment tomorrow. He is at least understandable at this point. He even had to go to work since the doctor would not give him an excuse; they are being very good about keeping him off of ladders and such but who knows how long it will last.

I hope we can figure out if the med is just relaxing stress, or if it is decreasing something neurological. Its always nice to have some answers, lol.

Thanks again,
Michelle

Univ of Pennsylvania, Institute of Neurology, Philadelphia
 

Charlie is right about the Movement Disorder Clinic at Univ of Penn. There are two Parkinson's neurologist there...

• Dr. Matthew Stern, Director, Parkinson's Disease and Movement Disorders Center, Department of Neurology, University of Pennsylvania Health System, Pennsylvania Hospital, whom Dottie and I see...and
• Dr. Howard Hurtig, Chair, Department of Neurology, Pennsylvania Hospital.

With regard to neurosurgeons, Dr. Gordon Baltuch, Director, Center for Functional and Restorative Neurosurgery.

All the neurologist are listed on this page: http://pennhealth.com/WagForm/MainPa...ind%2BProvider

Thank you, I will keep these names in mind. I did a quick check and It does look like they are covered under his network, but I dont have the card info in front of me. I asked him if it was HMO, PPO, POS or open and he gave me a grin like I was crazy. He cant recall them mentioning the nasty R word "referral", but the offices are helping him more than usual since he sometimes is clueless and I dont mean that in a bad way, just inexperienced.

Thanks again,
Michelle

Update today
 

Today he saw the head of neurosurgery at the large local hospital. He has been reassured that the cyst can not cause the issues he has. This doctor spoke to him and had a great bedside manner. Although he didnt like the answers, he was accepting because of this.

The doctor said anxiety is probably increasing whats going on, but he doesnt feel that it can be the cause at this point. I got second hand info today since my mother took him to the doctor, so I am not sure what else was discussed.

He is being referred to a movement disorder clinic, the doctor would like us to go to Toronto or NYC, 12 and 4 hours respectively. Carolyn, I didnt send those 2 names along, but my Mother is going to call the doctor with them and see if he feels they could start closer to home. 1 1/2 to Philly is better than NYC or worse yet Canada (dont we need a passport to do that now?).

Thanks all