A member presented a medical case:
Spasticity and stiffness makes it hard to move around, in a 77 year-old.
77 year-old man with spasticity and stiffness in his back and limbs, causing great difficulty in mobility.
Close details
Patient demographics
Gender
Age
77
Ethnicity
White or Caucasian
Occupation
Retired
Chief complaint or problem to solve
Still the muscles as always,never changes,as soon as i stand up my muscles contract,pulling my shoulders to my neck,pulling my back,unable to bend my legs ,squeezing my head so hard ,thinking is affected,squeezing my lower legs causing feeling to be nearly zero in my feet,making walking nearly impossible.All from a brain that was slowed ,tranquilized,by years on Benzos ,being speeded up when they are taken away ,causing the brain to hyper excite the muscles.( Benzos being a great muscle relaxer)
Case history
Was given lorazapam in 2004 ,was supposed to take it one month I think,but changed doctor and was given refills in ever increasing doses until I started blacking out and i thought it was from the 8 mg daily lorazapam. I asked to be taken off. The hospital did a 4 day detox with phenobarbitol and sent me home to a nightmare ,32 months later I can't walk more than room to room as my muscles contract wanting to pull them from the bones.My head muscles want to squeeze my head so tight ,it affects my thinking. 3 doctors have not been able to help.

PMH: Paws from a Benzo in
Meds: Synthyroid
Allergies:None known
Other tests: All blood tests are normal
Xrays:
Procedures:
Purpose of case discussion
Other: Need help as my life is on hold ,no one realizes how severe and delibitating this is.
Supplemental Materials

Dr. Ilene Ruhoy
Neurology
5 doctors agree

In brief: Neurologist

Patient should definitely be seen by a neurologist for testing.
Electrodiagnostic studies, imaging, and labs can provide objective evidence to better understand physiology and offer perhaps more effective treatment and management options.

In brief: Neurologist

Patient should definitely be seen by a neurologist for testing.
Electrodiagnostic studies, imaging, and labs can provide objective evidence to better understand physiology and offer perhaps more effective treatment and management options.
Dr. Ilene Ruhoy
Dr. Ilene Ruhoy
Thank
1 comment
Dr. Bert Liang
Agree. This needs some level of localization done by exam and neurophysiologic studies like EMG and NCV.
Dr. Mark Fisher
Neurology
4 doctors agree

In brief: I agree, BUT...

Are you using "spasticity" correctly? A lot of laypeople throw the term around without really knowing what it means.
"Spasticity" has a very specific neurological definition and description and is caused by a clearly defined spectrum of disease entities. True "spasticity" is a sign of a serious problem. Before you use the term "spasticity," make sure it's correct.

In brief: I agree, BUT...

Are you using "spasticity" correctly? A lot of laypeople throw the term around without really knowing what it means.
"Spasticity" has a very specific neurological definition and description and is caused by a clearly defined spectrum of disease entities. True "spasticity" is a sign of a serious problem. Before you use the term "spasticity," make sure it's correct.
Dr. Mark Fisher
Dr. Mark Fisher
Thank
Dr. Steven Simon
Physical & Rehabilitation Medicine
3 doctors agree

In brief: Need accurate dx

Spasticity should not be caused by benzo withdrawal.
However, baclofen makes sense at 10 mg 4 times daily increasing to 20 mg QID if needed. Zanaflex (tizanidine) is also good, but causes drowsiness so start 1-2 mg QID increasing to 4mg QID prn. MRI brain is warranted to make sure he hasn't had a CVA, then start physical,therapy including pool,therapy for muscle stretching and balance and gait training.

In brief: Need accurate dx

Spasticity should not be caused by benzo withdrawal.
However, baclofen makes sense at 10 mg 4 times daily increasing to 20 mg QID if needed. Zanaflex (tizanidine) is also good, but causes drowsiness so start 1-2 mg QID increasing to 4mg QID prn. MRI brain is warranted to make sure he hasn't had a CVA, then start physical,therapy including pool,therapy for muscle stretching and balance and gait training.
Dr. Steven Simon
Dr. Steven Simon
Thank
Dr. Edward Workman
Pain Management
2 doctors agree

In brief: You have a hyperspasmodic disorder

The question is what is the cause.
There could be many from basal ganglia problems in your brain to spinal problems in the lumbar spine vs. a more generalized muscle disease. First start with a neurology evaluation. That should obviously include a detailed physical exam, but more importantly imaging of the brain and the spine. That should lead to a reasonable working diagnosis. Chances are you may respond to a trial of baclofen a strong anti-spasmodic without the downside of benzos.

In brief: You have a hyperspasmodic disorder

The question is what is the cause.
There could be many from basal ganglia problems in your brain to spinal problems in the lumbar spine vs. a more generalized muscle disease. First start with a neurology evaluation. That should obviously include a detailed physical exam, but more importantly imaging of the brain and the spine. That should lead to a reasonable working diagnosis. Chances are you may respond to a trial of baclofen a strong anti-spasmodic without the downside of benzos.
Dr. Edward Workman
Dr. Edward Workman
Thank
Dr. Alvin Wells
Internal Medicine - Rheumatology
2 doctors agree

In brief: Stiff man syndrome

This is a case and were a specialist such as a rheumatologist may be able to provide additional input.
The differential includes polymyalgia rheumatica versus mixed connective tissue disease versus stiff man syndrome. In many cases, a trial of prednisone will offer a therapeutic and diagnostic benefit.

In brief: Stiff man syndrome

This is a case and were a specialist such as a rheumatologist may be able to provide additional input.
The differential includes polymyalgia rheumatica versus mixed connective tissue disease versus stiff man syndrome. In many cases, a trial of prednisone will offer a therapeutic and diagnostic benefit.
Dr. Alvin Wells
Dr. Alvin Wells
Thank
2 comments
Dr. John Goldman
May benefit from a muscle relaxant
Dr. Felix Brizuela
Here in the Pittsburgh area, I have a hard enough time getting Rheumatologists to commit to a diagnosis of Lupus or Rheumatoid arthritis. A Neurologist alone should be responsible for diagnosing stiff person syndrome. Stiff person syndrome is nothing like fibromyalgia. I call Stiff person syndrome fibromyalgia on steroids.
Dr. Mark Galperin
Pain Management
2 doctors agree

In brief: Spinal stenosis

look into the fact that you are 77 years old and your spine is also 77 years old, ask for c- and l-spine MRI, than we can talk

In brief: Spinal stenosis

look into the fact that you are 77 years old and your spine is also 77 years old, ask for c- and l-spine MRI, than we can talk
Dr. Mark Galperin
Dr. Mark Galperin
Thank
3 doctors agree

In brief: Spasticity?

The description raises a question of Stiff Man Syndrome, but there are other causes of spasticity in this age group, especially Motor Neuron Syndrome.
There is a strong need for a neurologist, and further testing to uncover the full dimension of this. An anti-spasticity agent given orally or even via a pump may help depending upon ultimate diagnosis, which is yet to be established. Would recommend a visit to a nearby medical school.

In brief: Spasticity?

The description raises a question of Stiff Man Syndrome, but there are other causes of spasticity in this age group, especially Motor Neuron Syndrome.
There is a strong need for a neurologist, and further testing to uncover the full dimension of this. An anti-spasticity agent given orally or even via a pump may help depending upon ultimate diagnosis, which is yet to be established. Would recommend a visit to a nearby medical school.
Dr. Bennett Machanic
Dr. Bennett Machanic
Thank
Dr. Andrew Sherman
Physical & Rehabilitation Medicine
1 doctor agrees

In brief: Check the neck

True spasticity is typically from an injury to the brain or spinal cord.
Alternatively this could be a problem from stiff muscles called "stiff mans syndrome". For that syndrome benzos are effective however you have become immune to the effect. So we need a clear diagnosis - an neurologist or physiatrist or both should examine you again and get MRI of the neck, EMG of the muscles and decide the cause. IF it is stiff mans disease then maybe treatment of the immune system can help - it is called IVIG. Ask the neurologist.

In brief: Check the neck

True spasticity is typically from an injury to the brain or spinal cord.
Alternatively this could be a problem from stiff muscles called "stiff mans syndrome". For that syndrome benzos are effective however you have become immune to the effect. So we need a clear diagnosis - an neurologist or physiatrist or both should examine you again and get MRI of the neck, EMG of the muscles and decide the cause. IF it is stiff mans disease then maybe treatment of the immune system can help - it is called IVIG. Ask the neurologist.
Dr. Andrew Sherman
Dr. Andrew Sherman
Thank
1 doctor agrees

In brief: Need more info

the most common cause is cervical spine stenosis with myelopathy the least common cause is hereditary spastic quadriparesis

In brief: Need more info

the most common cause is cervical spine stenosis with myelopathy the least common cause is hereditary spastic quadriparesis
Dr. Galina Nikolskaya
Dr. Galina Nikolskaya
Thank
Dr. Alvin Lin
Internal Medicine - Geriatrics
1 doctor agrees

In brief: Go see ur FamilyDoc

Any injury? Trauma? Fall? Stroke? 1st find cause of spasticity & stiffness.
Then you can discuss treatment options. Bottom line, go see your Family Doc or Geriatrician. S/he may refer to Physical Therapist for add'l evaluation & treatment. Be leery of benzodiazepines & muscle relaxants that may impair your thinking process & increase risk for falls.

In brief: Go see ur FamilyDoc

Any injury? Trauma? Fall? Stroke? 1st find cause of spasticity & stiffness.
Then you can discuss treatment options. Bottom line, go see your Family Doc or Geriatrician. S/he may refer to Physical Therapist for add'l evaluation & treatment. Be leery of benzodiazepines & muscle relaxants that may impair your thinking process & increase risk for falls.
Dr. Alvin Lin
Dr. Alvin Lin
Thank
Get help from a real doctor now
Dr. Eric Weisman
Board Certified, Neurology
33 years in practice
9M people helped
Continue
111,000 doctors available
Read more answers from doctors