Severe nightly leg cramps in a 78-year-old man with Parkinson’s disease – could this be an OFF symptom?
My 78-year-old father has Parkinson’s disease and is currently taking Madopar (levodopa/benserazide) three times a day. His last dose is at around 9:00 PM.
Recently, he has started experiencing very painful cramps in his left leg in the early hours of the morning. The episodes occur almost every night at approximately the same time.
Some details:
The cramp is mainly in the left calf/leg.
It is extremely painful.
There is no obvious abnormal positioning of the foot or toes. His toes do not curl and his foot does not noticeably turn inward.
The cramp usually resolves quickly when he gets up, moves around and massages the area. He also used Voltaren (diclofenac) gel, and the pain went away almost immediately.
He takes magnesium bisglycinate (105 mg elemental magnesium) regularly, but the cramps have still started occurring.
His neurologist prescribed Neurontin (gabapentin) 300 mg at bedtime. It has not prevented the cramps, and unfortunately it caused dizziness and he had a minor fall.
The cramps seem to occur 6–8 hours after his last Madopar dose, in the early morning.
Previously, we also noticed that some of his leg cramps seemed to occur when the effect of Madopar was wearing off and improve after Madopar.
Would adjusting the timing of levodopa, rather than increasing gabapentin or magnesium, typically be considered by a neurologist?
Any experiences or advice would be greatly appreciated.