Episodic Mobility Issues In The Early Thirties: Causes And Prevention Tips

Episodic mobility problems have a wide differential diagnosis. You need to be conversant with the common symptoms, the red flags and when to approach an emergency room.

Mobility is an important attribute for independent functioning of an individual. Human beings score over other living beings in that they are mobile with the help of hindlimbs only and the forelimbs are utilised for specialised functions, which involve precision and dexterity. For a person to be comfortably ambulant various structures involved in locomotion need to be optimally functional. This includes the nerves, muscles, joints, tendons, ligaments and spinal cord. Central nervous anatomical structures including cerebrum, brainstem and cerebellum for maintaining balance are important. Sensory inputs from the eye, ears and sensations from feet are also vital in maintaining stance.

Mobility issues can be episodic or permanent. These problems were noted in the elderly previously. However, because of the fast-paced lifestyle, these complications are seen in the early thirties now-a-days. Episodic mobility problems have a wide differential diagnosis. The public needs to be conversant with the common symptoms, the red flags and when to approach an emergency room.

Common symptoms of episodic mobility

Low back pain associated difficulty walking is a common problem usually secondary to paraspinal muscle spasm which gets relieved with rest, analgesics and muscle relaxants.

• It could be due to a prolapsed intervertebral disc in the lumbar region or radiculopathy, which will need a specialist opinion and management.
• Sports injuries like muscle sprains are also common.
• Ligament and joint injuries are also sources of episodic restricted mobility.
• Compressive neuropathies can lead to temporary disability.
• Systemic conditions like periodic paralysis secondary to hypokalemia, although rare should be promptly diagnosed as they have an excellent prognosis.
• Other metabolic conditions like hyponatremia and hypoglycaemia can lead to ambulatory difficulty.

Causes of transitory mobility issues

Transitory mobility issues are common in patients with full-fledged neurological disorders. Here are some conditions that can cause this problem.

• Epilepsy patients can have short-lived walking trouble when they have complex partial seizures.
• Patients with multiple sclerosis and other demyelinating illnesses can have temporary episodes of immobility.
• A Parkinson's disease patient suffering from on-off phenomena is common.
• Myaesthenia gravis, a rare but eminently treatable neurological disease, is known to present with fluctuating neurological symptoms including dysmotility.
• Rarer neurological ailments like dural arteriovenous malformations can present with mobility issues.
• Common conditions like migraine can masquerade as gait ataxia and giddiness.
• Patients with depression and other mental health issues can present to the outpatient with gait difficulties.
• Side effects of certain medications can manifest as difficult ambulation.
• Several systemic conditions like low blood pressure and anemia can lead to similar issues.

Serious causes of episodic mobility

Then there are serious neurological diseases stroke which present with trouble walking as the initial symptom. They are called transient ischemic attacks (TIAs). Patients who have risk factors for stroke need to be especially watchful. Unfortunately, stroke risk factors are overwhelmingly seen in individuals in their thirties in recent days. The common stroke risk factors are hypertension, diabetes, dyslipidemia, obesity, smoking, alcoholism, stress and sedentary lifestyle. A patient of TIA can have weakness of the limbs, slurred speech or visual blur which lasts for five to ten minutes and then the patient recovers totally. It is estimated that around 15 per cent of stroke patients had experienced TIA. If these TIAs are recognised and treated promptly it saves several lives and lifelong disability of the patient and crippling of several families can be forestalled.

Prevention tips

Prevention is better than cure as the saying goes. What can one do to prevent mobility and the allied issues?

• Regular physical exercise will strengthen the neuromuscular system and address stroke risk factors.
• Adequate precautions need to be taken to prevent falls, accidents and injuries.
• A nutritious and healthy diet, which comprises of fruits, vegetables to prevent deficiencies is essential.

To sum up, there are innumerable causes for transient mobility issues even in the early thirties. A healthy lifestyle, early diagnosis and prompt treatment will go a long way in mitigating these conditions.

(This article is authored by Dr Shobha N, Consultant - Neurologist And Stroke Physician, Manipal Hospital Malleshwaram)