muscle twitches and tingling in hands and feet

I am a 42 year old male who, starting about 5 weeks ago,  had a sudden onset of muscle twitching in my left bicep (it went on for about one hour).  The next day i noticed that my left food had some tingling (pins and needle feeling). Over the past 5 weeks the tingling has spread to both feet and sometimes my hands. Sometimes there is a burning feeling in my feet.  The muscle twitching has spread to my entire body.  The twitches last only about 1 second, but when they happen they will occur in about 3-5 places around my body then stop (left tricep, right shoulder, legs, back).  This usually happens when my body is at rest, but not always.  In addition, my left hand has been falling asleep at night.   also have had some "prickly feeling" on my thigh and right arm. this was only present for a day or two and is not occurring now.

Other information.  I have a hx of gi issues and was on rifaxamin twice in Jan and Feb of this year. I also had gall bladder surgery in Dec 2011 and then got shingles in Jan (my doc thinks it may have been triggered by operation). I also started cymbalta (60 mg) in early Jan (for anxiety).  So i was on both meds when this started.    

I saw my PCP last week.  He did some tests (thyroid, electrolytes, Sed rate, checking for muscle breakdown, vitamin b ect) that all came back normal (sed rate was like 4).  He gave me a vitamin B shot. My PCP states that he is not worried about MS at this time.  He states that it is not that common in men my age and does not feel my symptoms are compatible with MS (no optical problems, no walking issues).  At this point he does not want to refer me to a neurologist.

I am not worried about ALS, but i am concerned about possible MS.

Questions:
1. Does this presentation sound like MS?
2. Do you think a neurological eval is warrented at this time?

Thank you for taking the time to look this over.

sincerely,
stephen

[Shiv Kumar, MD]

Dear Stephen,

Thanks for writing in.

1)    Regarding the list of symptoms presented to me I am sure you are not suffering from either amyotrophic lateral sclerosis (ALS) or  multiple sclerosis (MS). Most of the symptoms like benign fasciculations, burning feet syndrome and multiple sensory symptoms looks to me like related to your anxiety rather than true neurological disease.

2)    So I personally feel you have "Benign Fasciculations" and more of anxiety neurosis. At present you do not have symptoms related to either ALS or MS. You need to see a neurologist only additional symptoms occur. Do continue on your vitamin supplements

I hope you find my response to be both helpful and adequate. If you have any additional concerns regarding your question I would be happy to address them.

Thank you for using MedHelp's "Ask an Expert" Service, where we feature some of world's renowned medical experts in their fields. Millions have benefitted from our service to get personalized advice for them and for their loved ones.

Best Regards,
Dr. Shiva Kumar R

[stephenpd69]

thanks for responding.  i am trying to manage my anxiety as best i can.  i have an appt with a neuro dr in 4 weeks.  my dr is going to order an mri next week  (most likely to calm my mind).  I am wondering:  i have read that a neg mri does not completely rule out ms.  Is this true? also i have read that getting ms when you are older (my case being 42) is worse as you usually get "primary progressive"
i wouldn't be so scared of MS if it did not potentially involve being physically disabled (wheel chair bound).

stephen

[1vet]

I am 59 and was DX'd in sept of 2011. 1st you may only have RRMS! It almost never goes full blown anymore with all the MS drugs and you would need to get on one as soon as possible! Dr will tell you. I would not be to woried at this point cause you have no clear DX yet.

[stephenpd69]

met with neuro yesterday. did a physical exam and test to assess my nerve functioning.  he said that there was nothing remarkable.  he suggested my pcp do some labs. i can see the neuro in 3 months if i do not improve, or sooner if new symptoms.  he did not think it was ms and saw no reason for an mri.  he was not the most engaging dr. he had an intern with him.  the two of them talked between each other.  i would have appreciated more communication, but oh' well.  still have tingling in my feet with some burning pain, esp left foot.  my hand feel better.  hopefully this will resolve on its own.  :)

[JMC72]

You could have spinal problems...

It really is annoying when doctors tell you it's stress or anxiety because only YOU know your body and if you don't feel good, then keep investigating...

I also would refrain from telling anyone you suffer from depresson, anxiety or any mental health issues because it will impede the investigation...

You have no idea how many doctors I went through before I had someone who would believe that it wasn't psychological and I had real symptoms...

I have had to spend much of my own money getting MRIs and CT Scans read by other doctors and things like that but it's worth it in the long run to know there is a cause for your problems.

Best of Luck to you.

Remember, push for the tests and remember to keep certain key words out of your patient info...