Case Study- Osteopathy and Epilepsy

I have a patient (male, 61) who is currently consulting me with shoulder pain radiating into left arm (L sided, upper and middle trapezius hypertonicity (HTN) and rhomboids HTN following the fitting of a pacemaker for AV syncope (13 months previously). Hyperkyphosis, chronic restrictions T1-3, T7-10, some forward head position, some restriction of L rotation upper complex, long term bradycardia and hypotension.

Patient suffered clonic-tonic epilepsy through adolescence and into adulthood (last episode 1977). Through persistence patient had anti-epilepsy drug regime reviewed, lowered and finally discontinued in adulthood. Cranial nerves nothing abnormal detected (NAD), Reflexes NAD, upper extremity myotome NAD.

I proceeded with a normal osteopathic treatment. However, during lower extremity assessment (patient jogs 3-4/week), moving the patient's left leg was met with resistance. Most likely (as it was the patient's first time with an osteopath) just the patient no being able to relax, but tonic rigidity lept to my head. Asked the patient to turn he gaze to my eyes, and he complied and appeared lucid.

Any reflections, advice, discussion etc.

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community teamPermalink Reply by Kiran on September 6, 2011 at 1:11pm

May I ask, when you say "met with resistance" could you still move the lower extremity LEx (like moving a limb through very thick mud) or did it resemble a tetanus type stiffness (pretty darn locked in position)?

Also is he on any anti-hypertensive meds at all?.. or any medications for that matter- just out of interest. I know anti-hypertensives can cause LEx abnormalities as do vit B12 deficiencies (mainly with gait but still perhaps something to consider?).

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Permalink Reply by Jonathan Grice on September 6, 2011 at 1:15pm

"Met with resistance" means as if the patient was consciously resisting with 60% of muscle power. Eventually as the patient concentrated on relaxing the limb I was able to flex the knee to end of range.

Patient on no meds at all.

Kiran Ul-Haq said:

May I ask, when you say "met with resistance" could you still move the lower extremity LEx (like moving a limb through very thick mud) or did it resemble a tetanus type stiffness (pretty darn locked in position)?

Also is he on any anti-hypertensive meds at all?.. or any medications for that matter- just out of interest. I know anti-hypertensives can cause LEx abnormalities as do vit B12 deficiencies (mainly with gait but still perhaps something to consider?).