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Neurology (Expert Forum)
Opinions, anyone?
This forum is for questions and support regarding neurology issues such as: Alzheimer's Disease, ALS, Autism, Brain Cancer, Cerebral Palsy, Chronic Pain, Epilepsy, Fibromyalgia, Headaches, MS, Neuralgia, Neuropathy, Parkinson's Disease, RSD, Sleep Disorders, Stroke, Traumatic Brain Injury
Opinions, anyone?
by glenntaj, Nov 02, 2003 12:00AM
My problem: Burning, searing nerve pain of acute onset and unknown origin. It started 4/12 as a tingling in bottom of right foot and became a searing pain in four hours. In three days it was in my hands; in ten days, body-wide (I have not had a body part that hasn’t felt it--crown to toes). Intensity varies considerably, but some degree always present (haven’t found any real patterns yet). Intermittently, get achy tightness/weakness in backs of knees/thighs. Also, infrequently, minor dizziness. (As I’m now on 2400 mg/day Neurontin, hard to distinguish from those side effects.) Additionally, around 4/28, developed a severe, pounding headache, originally attributed by me to sinus infection (seemed to have that location), which increased for about two weeks, and then gradually faded over the next four weeks (took a lot of ibuprofen during that time). Have had numerous neurologic consultations, as well as dermatological, hematological, and infectious disease consults, was hospitalized in May for testing, and testing has continued. Only abnormal/unusual findings to date (in six months):
Epstein-Barr virus serology points (by antigen pattern) to reactivated infection;
Brain MRI has “collosal-septal irregularity” of undetermined significance (not considered to be “definite evidence” of multiple sclerosis, but might be “early sign”
Slightly elevated total complement level (168 units on 1 48-153 reference scale)
Skin biopsy at left ankle and thigh shows considerable cutaneous fiber reduction at the latter site, and some at the former. Also evidence of “abnormal branching” at t
Epstein-Barr virus serology points (by antigen pattern) to reactivated infection;
Brain MRI has “collosal-septal irregularity” of undetermined significance (not considered to be “definite evidence” of multiple sclerosis, but might be “early sign”
Slightly elevated total complement level (168 units on 1 48-153 reference scale)
Skin biopsy at left ankle and thigh shows considerable cutaneous fiber reduction at the latter site, and some at the former. Also evidence of “abnormal branching” at t
Doctor's Answer
by CCF-Neuro-M.D.-CS, Nov 07, 2003 12:00AM
The cause for small fiber neuropathy in most patients over the age of 60 is never found. Of the known causes, diabetes is the highest. Other disorders which could cause this include systemic amyloid, connective tissue disease, monoclonal protein abnormalities, toxins (such as alcohol, or some medications), and there is a group of genetic conditions referred to as hereditary sensory autonomic neuropathy.
There are several classes of drugs which can be used for symptom treatment, and they include the anti-seizure medication (Neurontin), Anti-depressants (Elavil, Nortriptyline), Anti-arrhythmic (mexiletine), opiods, and capsaicin.
Regarding treatment for the disorder, unless a cause is found there is no specific therapy. Also, the progression of the disease is unknown, and varies from patient to patient. Pain could indicate either worsening of disease, or in some instances recovery of function. I hope this helps, and sorry for the delay.
There are several classes of drugs which can be used for symptom treatment, and they include the anti-seizure medication (Neurontin), Anti-depressants (Elavil, Nortriptyline), Anti-arrhythmic (mexiletine), opiods, and capsaicin.
Regarding treatment for the disorder, unless a cause is found there is no specific therapy. Also, the progression of the disease is unknown, and varies from patient to patient. Pain could indicate either worsening of disease, or in some instances recovery of function. I hope this helps, and sorry for the delay.
Normal/negative test results include lumbar puncture (protein, bands, cells, etc.,), Chest X-ray, CT scan of chest/abdomen/pelvis, nerve conduction studies of all extremities, visual/auditory/somatosensory evoked potentials, CBC, Chem 7, PSA, liver function serology/urology, ESR, hemoglobin A1c, glucose tolerance test, thyroid function, vitamin B12 and folate levels, quantitative immunoglobulins, serum/urine immunofixation/electrophoresis, cryoglobulins, serum/urine heavy metals, Lyme, West Nile, HIV, HTLV I/II, ANA, ACE, RPR, rheumatoid factor, antineuronal nuclear, double stranded DNA, and Purkinje cell antibodies, and anti-MAG, SPGP, Hu, GM1, sulfatide, GQ1b, GD1b, GD1a, gliadin, transglutaminase, SS-A, SS-B, p-ANCA, and c-ANCA antibodies.
Questions:
If this is an acute idiopathic small-fiber neuropathy, and idea as to possible course/prognosis? (I keep asking this question, and keep getting “wait and see”!)
Any therapeutic/immunomodulating approaches possible, or just pain management ones?
Any other pharmaceuticals that might be indicated in pain reduction? (Neurontin damps it down some, but not all of the time.)
Any nutritional supplements that could be tried with little/no side effects? (I read a lot about alpha lipoic acid, B-12, omega 3-6-9 . . .)
It is possible that some of this pain represents nerve regrowth/reconnection? And, moreover, other than repeated biopsies, is there any way to track if this is getting better/worse, especially if pain level may not be indicative?
Thank you.
Would appreciate more follow-up, if possible, from any/all sources.