How to treat pseudo-Parkinsonism in me?

Question

Hello doctor,

I was diagnosed with bipolar I and placed on the tablet Lithium. But that resulted in massive tablet polydipsia. So, it was replaced with the tablet Haloperidol.

Next, it was replaced with tablet Sodium Valproate. Two years later, a specialist in involuntary movements prescribed me Tablet Quetiapine to get over the tardive dyskinesia, which had given rise to massive problems.

Five to six years later, it improved my movements, my speech, and my mental functioning, all of which had been affected negatively by the 20 years of the tablet Haloperidol. Then I changed over to tablet Lamotrigine and Oxcarbazepine.

Seven years ago, while crossing a railway bridge, I faced my extreme balance problem. I did not identify the source of it until recently, when I discovered it was caused by low dopamine. I reasoned it was my pseudo-Parkinsonism at play.

I started on tyrosine, tryptophan, vitamin B1, and velvet beans to increase the production of dopamine.

First, can you look at the PET CT scan images and tell me?
What are the issues with my brain as shown by the scan?
The substantia nigra is the part that deals with dopamine. Is it affected? And by how much?
What other observations would be significant in my case?

Please advise me about the next steps of treatment.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

As per your description history, you have been on tablet Haloperidol for many years. But your history did not describe any symptoms to mimic Parkinsonism (which you said was pseudo-Parkinsonism).

I would like to know those symptoms in a time sequence manner. Currently, what medications and at what dosage are you taking?

The FDG PET (fluorodeoxyglucose-positron emission tomography) scan, which you got, is reported as "No focal areas of hypometabolism in brain parenchyma". With this available history, I feel there may be the possibility of drug-induced extrapyramidal symptoms. Physical consultation would be appropriate for such a situation, instead of an online chat consultation.

Also, FDG PET is not diagnostic for such a condition. FDG PET scan looks at glucose uptake in cells, not dopamine. To look at the dopamine pathway, Tc - Trodat scan and Dopa-PET would be more appropriate. But that also is not a confirmatory diagnostic test. It has only a corroborative significance with clinical judgment. The main judgment would be clinical only. Real parkinson's (Idiopathic parkinson's disease) is also diagnosed mainly clinically, not by a PET CT scan.

I hope it helps.

Please let me know if I can assist you further.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

I have read your query and can understand your concern.

Urinary dopamine level is not a confirmatory test for Parkinsonism. The decision of medicines will be feasible by physical examination and a detailed long history.

Physical consultation seems to be needed in your case. You can look out for a movement disorder specialist, a subspecialty of neurology.

Till now, as per my knowledge, stem cell treatment is not approved for Parkinson's. If it is idiopathic parkinson's disease, deep brain stimulation is a treatment option, but that can not be decided on a chat or video consultation.

I hope it helps.

Please let me know if I can help you further.

Thank you.