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Dr. Frank
Dr. Frank, Board Certified Physician
Category: Neurology
Satisfied Customers: 9000
Experience:  Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
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I have been having jerking/muscle spasms all on my right

Customer Question

I have been having jerking/muscle spasms all on my right side of my body. It causes me to not sleep. I do have grand mal,but it has been over ten years since I had one of those. I always get these other things and I'm not sure what they are.
Submitted: 5 years ago.
Category: Neurology
Expert:  Dr. Frank replied 5 years ago.
neuromd2012 :


neuromd2012 :

I am an adult neurologist, and will attempt to answer your question. You are offline, so please review the following information and ask questions if you have them , or if you are asked to answer my questions, please do so and I will return to reply. If you feel you have recieved enough information and are satisfied, please hit the accept button as that is how I am compensated for my work. If you have additional questions, even after you have hit the accept, for example you now have lab results, please return and I will be glad to answer your questions. Please be aware that as a physician I cannot make a diagnosis without an examination, so this is for information purposes only and does not adhere to the role of a patient-physician relationship. Ok?

neuromd2012 :

are you in the chat room?

neuromd2012 :

please type something for me

Customer: I am here
neuromd2012 :


neuromd2012 :

so you have gen T/C seizures since when?

Customer: Since I was 11 years old
neuromd2012 :

was it febrile seizures at the beginning, or do you have a diagnosis?

neuromd2012 :

no history of meningitis or any known cause?

Customer: What is that all I know is that they said I had grand mal seizure
Customer: Not that I know
neuromd2012 :

ok and how much phenobarb do you take?

Customer: 90mg at night
Customer: Could these be myoclonic
neuromd2012 :

yes, that is what they sound like

neuromd2012 :

but it may be nocturnal myoclonus only, does it occur only at night?

Customer: If so what is recommended
neuromd2012 :

well I would add some klonopin, but I would do so in the context of weaning you down on the phenobarbital, as that might be the real problem

Customer: No I have been having them all day. Sometimes a startle could even make it happen
neuromd2012 :

so you have startle myoclonus

neuromd2012 :

we have great names in neurology, don' t we?

neuromd2012 :

have you ever tried klonopin?

Customer: Yes sometimes I feel lost in the words
neuromd2012 :

who put you and keeps you on phenobarbital???

neuromd2012 :

90 mg, what is your phenobarb level?

Customer: No I have tried keppra deprokote pheno teratology neurotin
Customer: My neuro from unassuming memorial hosp
neuromd2012 :

but you haven't had a GTC seizure in 10 years? why the changes?

neuromd2012 :

well if you want my opinion, phenobarb is like stoneages, nobody uses phenobarb anymore,

neuromd2012 :


Customer: For these episodes but nothing seems to help
neuromd2012 :

did he start the phenobarb for the startle myoclonus?

Customer: These happen so often in my life it's crazy
Customer: No I have been on pheno since I was a teenager
Customer: Someone could bump into me by accident and the episode will happen I don't know how to stop it
neuromd2012 :

well my approach in your situation would be an attempt to slowly, and I mean very slowly, wean you off the phenobarbital and start something like Mysoline as a replacement, and then probably change to klonopin later on, in an attempt to decrease your myoclonus without sedating you too much. Phenobarbital causes cognitive impairment, do you work?

Customer: For the past two nights they also start when I want to go to sleep. Which I can't because of it
neuromd2012 :

yes, well you might ask you neurologist if you could have some 0.5 or 1.0 mg klonopin to take right before you go to bed , before the myoclonus starts

Customer: Yes retail but it happens on the job. The job isn''t the only time. Like I said little things bring it on and it causes me to drop because of the right leg/arm spasms are so bad
neuromd2012 :

well that is my suggestion, you need to make some changes in your medications if you want my opinion, maybe find an epileptologist to treat you rather than a neurologist only, I don't prescribe phenobarb anymore, and I have been successful getting my patients off phenobarb, using drugs like Vimpat and Klonopin. you can function better

Customer: What is the difference
neuromd2012 :

I would push your keppra up to 3000 mg/ day if necessary, and drop both your phenobarb, and eventually maybe your dilantin, keep you on keppra and vimpat or klonopin

neuromd2012 :

big difference in these drugs, less cognitive impairment, less side effects, your myoclonus might be from being on the phenobarb for so long

neuromd2012 :

the newer drugs are better than the old drugs.

Customer: I get nervous changing meds so much cause I don't want to have a grand mal. How would I know that those meds would keep my grand mal under control
Customer: Why do you think that the pheno could be the cause.
Customer: Are you there
neuromd2012 :

That is about all I can add now. Please hit the accept button if you feel I have answered your question and that is how I get compensated for my time with you. thank you. dr Frank T.

neuromd2012 :

If you want literature about phenobarb I can find some for you

neuromd2012 :

then you aren't just taking my opinion

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