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Dear Dr. Roach: Yesterday, my right hand started shaking uncontrollably. It did not stop for two hours. My left hand has had issues for years, shaking mostly when reading the paper or holding something. I am 66 and have a number of underlying conditions, including two types of epilepsy. Could this be the focal form manifesting itself?

S.G.

Dear S.G.: Seizures have been categorized in many different and confusing ways, but currently, seizures are described as generalized — that is, affecting both sides of the brain, versus focal, which is just on one side. Sometimes people with epilepsy can have both focal and generalized seizures.

Generalized seizures can have motor symptoms (the most familiar are the tonic-clonic seizures, formerly called “grand mal”) or non-motor symptoms (such as the absence seizure, formerly called “petit mal”). Seizures may affect consciousness, or people can retain consciousness during seizures.

What you are describing sounds to me like a focal seizure without any impairment of consciousness. This also goes by the name of epilepsia partialis continua. This often happens in people with a history of focal epilepsy, especially in times of stress. The first time I saw this was in a gentleman who had very high blood sugar from unrecognized diabetes.

Dr. Roach Writes: After a recent column, several people asked me to comment on additional treatments for complex regional pain disorder (reflex sympathetic dystrophy). Ketamine is one new treatment. I received several letters from people who told me of the dramatic benefit they had with ketamine. Intravenous ketamine has been studied, and it showed some benefit in reducing pain scores, but the relief is not always long-lasting. Another approach used by some experts is the use of alpha blockers, usually used for blood pressure control. The blood pressure medicines prazosin and clonidine have been successful in some people. Low-dose naltrexone, normally used in treatment of addiction, has been reported in a case series to have remarkable efficacy.

Email questions to ToYourGoodHealth@med.cornell.edu.

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