How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

Ask healthydoc Your Own Question

healthydoc
healthydoc, Board Certified Physician
Category: Neurology
Satisfied Customers: 1986
Experience:  Board Certified U.S. Neurologist
55821379
Type Your Neurology Question Here...
healthydoc is online now
A new question is answered every 9 seconds

My wife is 58, previously in good health (non smoker, non drinker).

Resolved Question:

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!
Submitted: 1 year ago.
Category: Neurology
Expert:  healthydoc replied 1 year ago.

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.

healthydoc, Board Certified Physician
Category: Neurology
Satisfied Customers: 1986
Experience: Board Certified U.S. Neurologist
healthydoc and other Neurology Specialists are ready to help you

JustAnswer in the News:

 
 
 
Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.
 
 
 

What Customers are Saying:

 
 
 
  • I feel so much better today, and upon further investigation believe that there is a chance that the responses I got saved me from a serious, even life threatening situation. I am very grateful to the experts who answered me. Susan O. USA
< Last | Next >
  • I feel so much better today, and upon further investigation believe that there is a chance that the responses I got saved me from a serious, even life threatening situation. I am very grateful to the experts who answered me. Susan O. USA
  • Wonderful service, prompt, efficient, and accurate. Couldn't have asked for more. I cannot thank you enough for your help. Mary C. Freshfield, Liverpool, UK
  • This expert is wonderful. They truly know what they are talking about, and they actually care about you. They really helped put my nerves at ease. Thank you so much!!!! Alex Los Angeles, CA
  • Thank you for all your help. It is nice to know that this service is here for people like myself, who need answers fast and are not sure who to consult. GP Hesperia, CA
  • I couldn't be more satisfied! This is the site I will always come to when I need a second opinion. Justin Kernersville, NC
  • Just let me say that this encounter has been entirely professional and most helpful. I liked that I could ask additional questions and get answered in a very short turn around. Esther Woodstock, NY
  • Thank you so much for taking your time and knowledge to support my concerns. Not only did you answer my questions, you even took it a step further with replying with more pertinent information I needed to know. Robin Elkton, Maryland
 
 
 

Meet The Experts:

 
 
 
  • Dr. Mark

    Neurologist (MD)

    Satisfied Customers:

    1985
    Neurosurgeon - Brain, spine, and peripheral nerve surgery
< Last | Next >
  • http://ww2.justanswer.com/uploads/neurosurg/2009-10-06_120923_profile.jpg Dr. Mark's Avatar

    Dr. Mark

    Neurologist (MD)

    Satisfied Customers:

    1985
    Neurosurgeon - Brain, spine, and peripheral nerve surgery
  • http://ww2.justanswer.com/uploads/NE/neuromd2012/2012-6-6_171449_frank.64x64.jpg Dr. Frank's Avatar

    Dr. Frank

    Board Certified Physician

    Satisfied Customers:

    6629
    Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
  • http://ww2.justanswer.com/uploads/jesbrain2015/2010-5-21_162329_jack.jpg Jack Scariano Jr's Avatar

    Jack Scariano Jr

    Neurologist (MD)

    Satisfied Customers:

    1056
    Board Certified Neurology 1982 30 years experince. Also expert in Pain Medicine
  • http://ww2.justanswer.com/uploads/PR/pradocs/2012-7-23_23649_201272323220JApicture105x113.64x64.jpg Dr. Bob's Avatar

    Dr. Bob

    Neurologist (MD)

    Satisfied Customers:

    2846
    Neurology & Int Medicine (US Trained): 20 yrs experience
  • http://ww2.justanswer.com/uploads/HE/healthydoc/2011-7-22_193154_LevGrinman2.64x64.jpg healthydoc's Avatar

    healthydoc

    Board Certified Physician

    Satisfied Customers:

    1848
    Board Certified U.S. Neurologist
  • http://ww2.justanswer.com/uploads/BrainLifeDoc/2010-10-04_004701_AMF_2008_2_pix.jpg Dr. F's Avatar

    Dr. F

    Board Certified MD

    Satisfied Customers:

    266
    Neurosurgeon with more than 20 years experience in practice and teaching.
  • http://ww2.justanswer.com/uploads/Phytube/2010-9-7_192331_PicVB1a_164by64.jpg Phytube.com's Avatar

    Phytube.com

    Neurologist (MD)

    Satisfied Customers:

    86
    Pediatric Neurology and Developmental Medicine with Special Research In Pain Medicine/Medications
 
 
 
Chat Now With A Neurologist
healthydoc
healthydoc
1851 Satisfied Customers
Board Certified U.S. Neurologist