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Psychiatrist Just Threw A Wrench Into The Gears?

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#1 3.8jake



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Posted 23 October 2013 - 10:01 PM

After listing a bunch(a lot)  of symptoms with my current sleep specialist that I was concerned about if they were because of narcolepsy, she referred me to a Psychiatrist who specializes in sleep medicine as well as other neurological disorders...First order of business was that he ordered blood test to check for a narcolepsy gene and 4 neurotransmitters and B vitamins... Dopamine came back too low to measure in a lab (this result was reconfirmed by lab) and negative on the gene for narcolepsy(I know its not absolute)...


After seeing a neurologist today who was absolutely positive that I don't have Parkinson disease(family history of young-onset Parkinson)

I'm now waiting on results for my MRI of head and EEG and yet another blood test looking for Vitamin D and a few other things(don't remember) that the neurologist ordered.  Next Monday I get to see a different neurologist who specializes in sleep medicine...


So I guess now based on my earlier "partial narcolepsy" diagnosis and combined with medication's is making me wonder if I have secondary Narcolepsy?  Can MS cause very low dopamine levels?  Anyone know if Provigil or Dexedrine can cause that side effect of no dopamine?


Update 10/24:

 MRI reported the following:

"Mild right cerebellar tonsillar ectopia is identified measuring 5 mm which is borderline for Arnold Chiari



Which is interesting as my 2011 MRI had no such remarks...

#2 Ferret



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Posted 24 October 2013 - 11:27 PM

Please keep us updated on your tests and results.
Contrary to the heading of your post, I feel that you are getting excellent diagnostic testing to eliminate any other possibilities for your EDS. It would be wonderful if all Doctors were as thorough.
Best of luck on your journey of discovery.

#3 Potato



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Posted 25 October 2013 - 11:07 PM

You do have dopamine in your brain, I guarantee it. Otherwise you WOULD be showing signs of Parkinson's disease. The motor function issues with that disease become apparent typically after around half of the dopamine producing neurons are destroyed. That is still well before the brain reaches extremely low dopamine levels in absolute terms.


I'm not sure what diagnostic test they were using to determine your dopamine levels, but keep in mind it's practically impossible to accurately measure the amount of neurotransmitters in the brain. For one, they are synthesized inside the CNS and do not freely cross into the bloodstream due to the brain blood barrier. Levels also fluctuate rapidly as they are synthesized, secreted, and subsequently degraded or transported back into the cells. Peripheral dopamine levels in particular can skyrocket after a large meal. Generally when blood tests are done for neurtransmitters or their metabolites, they're only looking for an excess amount since that can indicate an endocrine/neurotransmitter secreting tumor. It's difficult to draw any specific conclusions when the levels are low except in rare instances, such as a beta hydroxylase deficiency that results in a large amount of dopamine and little to no epinephrine/norepinephrine.


As far as your MRI results, I'm sure by now you've found that an Arnold-Chiari malformation wouldn't result in impaired dopamine generation as that malformation is relating to the cerebellum, whereas the dopamine generating neurons are located in the substantia nigra. And while the malformation may play a role in your excessive daytime sleepiness, it doesn't sound likely unless you're experiencing other symptoms which may also occur as a result of the malformation.


I think this is a case where really you'll just have to go through all the diagnostic tests they want to have done and see what their opinion is once they have the results. Good luck!

#4 3.8jake



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Posted 28 October 2013 - 03:22 PM

Sorry, my post heading may be misleading some into thinking that I'm not grateful for the psychiatrist, which isn't the case.  The Neurologist doesn't seem concerned with the chiari, but noted a low vitamin D3 (15 vs 30-100) and a positive ANA and has referred me to a rheumatologist.