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Subject: Re: Fatigue + fasciculations + cramping
Forum: The Neurology and Neurosurgery Forum
Topic Area:
Posted by CCF Neuro MD *!* on December 22, 1997 at 12:19:17:
In Reply to: Fatigue + fasciculations + cramping posted by Larry Berger on December 02, 1997 at 10:41:28:
: I've been plagued over the last two years with the major symptoms being extreme fatigue, leg cramps and stiffness, and fasciculations. Clinically a muscle biopsy showed 'early groupings of neurogenic atrophy',
a slightly elevated CPK and other muscle enzymes and a EMG showed only muscular irritability (undiagnostic).
DNA testing was negative for Kennedy Disease. A researcher in Chronic Fatigue Syndrome did not think I fit his profile of 400 CFS patients.
I've slowly gone from being quite active-full time work, gardener, basketball player, etc. to mostly housebound by this unexplained illness. I am unable to stay on my feet for very long due to extreme cramping-when they are not cramping they feel numb and weak. When I tense my thigh muscles they tremor and visibly fasciculate.
I also experience tension tremors in fingers and on occassion full body tremors. The fatigue I experience is now overwhelming and when I push myself too much I get fatigued to the point of even finding it hard to breathe.
I've been through the doctor mill and am astonished at the lack of concern on their part. A neurologist told me to take vit E and come back in a year if the symptoms progress. Meanwhile I feel unemployable (unless you know of any jobs as a mattress tester?) I was a Respiratory Therapy Dept. Director until I had to give up my position due to this illness. Without a diagnosis filing for disability would be futile.
Can you please shed some light on what is happening to me and suggest a treatment.
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This is a very complex situation and it sounds like you need a re-evaluation by a neurologist specializing in neuromuscular disease. The findings consistent with neurogenic atrophy on the EMG is hard to dismiss, and the description of increased irritability on the EMG is consistent with the sort of nerve problem where innervation is gradually withdrawn from muscles.
Your description of fasiculations is also significant as it is further evidence of denervation of muscle,
the possible background causes of this pattern are quite numerous and it would be impossible to give an adequate differential based only on a description.
I would agree that Chronic fatigue is not high on the list of possibilities and something which is as common and relatively easily diagnosed as ALS, should have been recognized a long time ago.
At this stage therefore the best I can do is suggest the direction for further investigation, namely a neurologist specializing in neuromuscular disease.
If you wish to be evaluated at the Cleveland Clinic Neuromuscular disease section the number for appointments is (216) 444 5559. This information is provided for general medical education purposes only.
Please consult your physician for diagnostic and treatment options of your specific medical condition.
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