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healthydoc
healthydoc, Board Certified Physician
Category: Neurology
Satisfied Customers: 1986
Experience:  Board Certified U.S. Neurologist
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My wife is 58, previously in good health (non smoker, non drinker).

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My wife is 58, previously in good health (non smoker, non drinker). On dilantin for 25 years for seizures. In past 6 months has developed progressively worse ataxia (almost in wheelchair), slurred speech, double vision, involuntary twitching in face and feet, loss of appetite and weight (40 pounds), impaired cognition, poor bladder and bowel control. Seeing neurology team at University of Colorado Hospital. 3 MRIs, 2 spinal taps, many blood labs. No diagnosis. White matter abnormalities in MRI, and cerebellum has shrunk since January. Ruled out MS, paraneoplastic syndrome, JC virus, dilantin toxicity, and a hundred other things. Running out of time. Help!

healthydoc :

Hello and thank you for your question.

healthydoc :

Did she have EMG nerve conduction test?

healthydoc :

There are patients who has history of lymphoma who later on develop paraneoplastic diseases specifically paraneoplastic cerebellar degeneration. These patients have antipurkinje cell anti bodies have they tested for this antibodies or which antibodies have they tested?

Customer:

Thanks for your reply. No, she has not had a EMG test yet. I will ask her neurology team about that.

Customer:

I realized I never told you she had lymphoma - which you brought up - but she did. Was diagnosed in 2001 and treated through 2006. Her neuro team knows what chemos she got. They were concerned about methatrexate (?) as a possible cause of her condition, but she did not receive that chemo drug. They tested for paraneoplastic disease, but I am not sure which one(s). The paraneoplastic disease tests they did came back negative. They started a large number of blood tests on Monday - some will take several days to get back. I don't know if they have tested for antipurkinje cell antibodies - I will find out.

Customer:

I found a reference on a cerebellar ataxia website to dilantin (phenytoin) as a possible cause of that condition. My wife has been on dilantin for over 25 years. Could that be the culprit? We are transitioning to another anti-seizure med but that transition is gradual and takes another 3 weeks.

healthydoc :

Yes it is possible that long term use of dilantin can lead to cerebellar atrophy. here is one article which would be helpful to you. Also find out about which antibodies they tested.

healthydoc :

http://onlinelibrary.wiley.com/doi/10.1002/ana.410070106/abstract

healthydoc :

If you have no further questions than please rate my answer positively. Thank you.

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