I developed blepharospasm a few months after taking an antiemetic for migraine with vomiting (Domperidone).
This “twitching” was then made worse and spread after another drug my gp prescribed (Sertraline).
I also developed insomnia so my gp prescribed another drug (Amitriptyline).
A movement disorder specialist diagnosed dystonia, chorea and myoclonus.
He told me I had a “tic”. Then he prescribed another drug Sulpiride.
I was not informed this could make things worse/permanent.
I was told “it” would go away by itself. “It” has not.
Then I was given another drug Benzhexol. I was not told it was an anti-parkinson’s drug.
I have akathisia, tardive dystonia, tardive dyskinesia and Parkinson’s.
I have never taken levodopa. No thank you.
Sinemet Plus 25 mg/100 mg Last updated on emc: 18 Jul 2022 For Healthcare Professionals
4.8 Undesirable effects
The most common are dyskinesias including choreiform, dystonic and other involuntary movements …
Muscle twitching and blepharospasm may be taken as early signs to consider dosage reduction.
L-Dopa Therapy in Parkinson’s Disease A Critical Review of Nine Years’ Experience A.Barbeau Canad.Med.Ass.J., Dec.27, 1969, vol. 101.791.
TABLE VIII…DOPA-Induced Dyskinesias
…we have listed most of the manifestations observed in our 80 patients with Parkinson’s disease…they occurred in 50% of our parkinsonian patients, but could certainly be found in almost 100% if the level of L-dopa was pushed sufficiently high
- CEPHALIC DYSKINESIAS
(a) Ophthalmic: Pseudo exophthalmos: “wide-eyed” or astonished expression, with lifting of eyebrows. Episodes of rapid blinking. Sudden blepharospasms as if in intense concentration and often with hand gestures. Sudden lateral deviations of eyes with or without rotation of head. Short-duration internal strabismus with blurring of vision. Intermittent mydriasis.
(b) Facial: Unilateral rictus with or without short-duration hemifacial spasm. Trismus. Asymmetrical choreic or myoclonic movements of face (cheeks),
(c) Oro-bucco-lingual: Rapid, short-duration protrusion of the tip of the tongue. More prolonged protrusion with rhythmic and rolling movements of the tongue and licking motions. Clicking and smacking of lips and tongue with or without gnawing.
Lateral or rotatory movements of lips and chin, sometimes like chewing, sometimes like rumination. Rhythmic clicking of dentures (from tongue, cheek and jaw movements). Rare palatal myoclonus. Vocalization changes (nasal voice, slurring) with marked tongue movements.
(a) Respiratory: Hyperventilation, “air hunger” dyspnea, with panting. Myoclonic jerks of diaphragm and intercostal muscles, (b) Postural: Whole body rocking when sitting. Oscillations (“swaying in the breeze”) while standing.Oscillatory movements of the pelvis (“belly-dancing”). Compensatory lateral flexion (scoliosis), either occasional or constant and progressive. Opisthotonic posture. Acute akathisia anxiety reactions with inability to stay in one spot.
UPPER EXTREMITY DYSKINESIAS
(a) Proximal: Slow wing-like flapping of entire arm, with elbow moving most. Internal rotation with extension and retroversion of arm. True ballistic movements (“arm shoots out”). Slow reptilian motion of arm with extension of hand and fingers alternating with flexion (athetosis).
(b) Distal: Rapid jerking movements of fingers with or without extension and spreading. Restlessness of hands and increased gesticulation (“latinization”). Saccadic (3 per sec.) lateral movement of whole hand from the wrist. Tremor modification: increase in amplitude in initial phase of treatment (with diminishing rigidity) followed by decrease in rate and amplitude.
LOWER EXTREMITY DYSKINESIAS
(a) When lying down: Extension spasms of legs (kicking). Restlessness (akathisia).
(b) When sitting: Balancing motion of the leg from the knee: movement like organ player (lateral) or shuflling (back and forth) or mixture of both types. Lateral oscillations of knee or ankle. Rocking motion of foot resting on floor: alternate lifting of toes or heel. Rhythmic spreading of toes.
(c) When standing: Constant shifting from one foot to the other (akathisia).
(d) When walking: Internal rotation of ankle progressing to whole limb internal rotation and circumvolution. Slow wave-like motion of foot (athetosis). More rapid, sudden, propulsion of whole limb (ballismus).