53 yr old female with uncontrolled abrupt movements of fingers and toes

 NOTE: THIS IS AN ONLINE E LOGBOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS / HER /GUARDIAN'S SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR INDIVIDUAL PATIENT'S PROBLEMS THROUGH A SERIES OF INPUTS FROM THE AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS INTENDING TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE-BASED INPUT.

PATIENT HISTORY: Pt is a 53 yr old female, a school teacher by profession.

She was completely alright 7 yrs ago. 

For the past 5-7 yrs, she started noticing uncontrolled movements of her fingers toes, and sometimes lips associated with no other symptoms (such as loss of sensation, weakness in grip strength, etc). With time it is becoming more severe (at present, each episode lasts for 10-15 mins, 2-3 times/day; throughout the day, not during sleep). She also c/o her fingers and toes feeling cold and sudden profuse sweating.

To date, she had fallen 3 times while getting on a bus (lost balance suddenly, but no loss of sensation). While at home 2 times she fell down while walking. Each time she could get up on her own after 1-2 mins.

For the past 2-3 yrs she c/o not been able to recognize a person whom she met just two days back i.e recent events, but do remember all her childhood memories. 

Previously she could speak Hindi and English fluently but for the past 2-3 yrs she is having trouble recalling words to form sentences in Hindi or English. On inquiry, she told that her writing speed and handwriting have deteriorated quite noticeably. 

Her symptoms had not yet affected her professional and personal life but is quite afraid that it may affect her soon. She can carry out all her work on her own to date.

She has no history of HTN, DM

She started alcohol consumption at the age of 24 yrs i.e after getting married. Drinks 2-3 pegs (100-150ml) occasionally 1-2 times/ yr.

CURRENT CHIEF PROBLEMS  AND PATIENT'S REQ.: c/o progressive uncontrolled abrupt movements of fingers and toes for past 7 yrs.

FAMILY HISTORY:

Maternal grandfather - when pt was 5 yrs old she saw her grandfather having difficulty in walking or talking, with involuntary abrupt movements of the whole body, and would often fall down. He was bedridden and passed away a few months later.

Mother - Till 56 yr she was fine. At the age of 56, c/o involuntary abrupt movements of fingers and toes, later progressing to the whole body, so used to sit on a chair max time of the day. She became moody and would lose her temper often. Within a year she found it difficult to speak. She too had a few episodes of falls and was bedridden for 2 months, before passing away at the age of 58.

Brother - At the age of 48, he started similar complaints (abrupt uncontrolled movement of fingers, hands, and feet). His condition is deteriorating faster as claimed by his family members. He is getting agitated and loses his temper often. Provisional diagnosis Huntington's disease.

Mom's sister A- At age 53 similar complaints progressed the same way making her bedridden. Finally died at the age of 60 yrs.

Mom's sister B- At age 55 similar complaints. Now bedridden