Fibromyalgia or MG or Parathesia

    Dr.Nicholson,  I am  68, male having neuropathies (tingling, burning)/changes in voice/strong sense of smell.  Mild in AM and gets worse in PM - usually no problem while sleeping. When I doze off  in a chair, it starts and doesn't quit until sleeping.  Initially,  ptosis in left eye, stiffening of tongue after eating and talking that affected my speech - still a problem. Sensations have been worse on my left side including eyes.  Worse in the evening and stop when I go to sleep. Started after a skin infection and being hospitalized for low blood sodium, low vitamin D and atrial fibrillation - may have picked up a virus in the hospital.  I've had Herpes II for 30 years and paroxysmal Afib for 25 years. I see new little red spots on my arms, legs and back which I've read can be related to H. Zoster. Neurologist gave a  brain MRI, urine and blood tests and an EMG test all negative for  but a Myasthenia Gravis panel was positive for antibodies - he said it was probably a false positive, so repeated it and was positive but lower readings. A small fiber EMG and it was borderline. He still thinks it is not full blown MG because I lack extreme weakness in arms and legs. His only diagnosis so far is some sort of neuropathy/parathesia. A rheumatologist found very low Vitamin D - all  other immune systems disorders were negative. She believes I have a mild case of fibromyalgia but also believes I don't have classic Myasthenia Gravis. I do have extreme fatigue and weakness some days.
Questions:   Do you think I have an immune mediated neuropathy, possibly small fiber and not actually have MG, in some sort of remission ? How long must I be in remission to be safe. What can I do to halt/ reverse the MG?  Why does it start (tingling) when I doze off in my chair?  Do you think it is caused by a virus - If so can I do a series of tests to determine which virus it is and treat it?  What should be my next step? Which tests?  Thank You

[Garth L Nicolson, PhD]

I can’t really diagnose you, but your condition may be caused by chronic bacterial or viral infections that commonly cause peripheral neuropathies.  These infections can invade the peripheral nerves and cause all sorts of nerve conduction and sensitivity problems.  There are a number of viral and bacterial infections that could be involved, and you mentioned one yourself, Herpesviruses, and there are bacteria, such as Mycoplasma, that have also been found in peripheral neuropathy cases.