Odd symptom onset

[TJM24]

Hello everyon and Quixote thanks for referring me to post my question here.  About three weeks ago, I woke up with tingling/pins and needles sensations in my left foot. I had it a bit in my right foot too but mostly in my left.  It went away once I walked around but kept coming back mostly at night.  Then a few days later out of the blue I woke up with twitching in my calves and feet (more on the left leg ).  The twitching was everywhere (arms, hands, face, eye).  This literally came on over night.  The twitching gets mostly better for a day or two and then its back.  I don't notice any weakness or loss of coordination.  Really its mostly twitching and mostly in my calves and feet and some pins and needles in the left lower leg/foot.  My doc dismissed it as stress or viral induced although he ran a bunch of blood work all normal.  The thought of MS or ALS have been playing havoc with me.  Although I try to tell myself the sensory symptom (pins and needles) point away from ALS and the twitching isn't likely MS.  Also the overnight onset doesn't sound like the former.  Any ideas?  Thanks,

[essdipity]

Hi, TMJ, and welcome to our forum. You'll find good help and lots of info here, and no one will sneer at you.

In general, all over fasciculations are not part of MS. There's a disorder called benign fasciculation syndrome, that you might want to check into. In fact, there are lots of things that could be causing all your symptoms. If you haven't seen a neurologist, make that a big priority. I hope you don't have MS or anything else serious, but before that can be determined, you need a lot of rule-out tests, including MRI. It's even possible that you have some sort of nerve impingement.

Good luck and keep us informed.

ess

[PastorDan]

Good morning, and welcome aboard.  Based on my 3+ weeks of experience, I will say categorically that you will find a great many people here who are knowledgeable, caring, and often (Quix is a great example) both!

I don't think I'll be the one to find the answers to your questions, but I'll suggest a couple more that you might want to think about.

Firstly, if your doc thinks this is stress induced, did he give you any advice or help toward resolving either the cause or the reactions to it?  If so, are you following his advice?  Pehaps you should explore this with him a little more, and adopt ways of dealing with stress that really deal with it, instead of being like most of us men, who just put forth a strong face and let ourselves believe we can tackle anything, suppressing our true and often legitimate concerns.  Maybe he'll suggest exercise (yeah, I hated when my last doc would bring that up), dietary adjustments, some pharmaceutical assistance, and/or finding someone with whom you can talk through your stress inducers.

Secondly, my first thought whenever I hear about tingling or pins & needles (until my current symptoms began, and I came here to learn more about them) has always been a circulatory problem, especially upon waking.  When we were kids (that was a long time ago, trust me), when one of us would wake up with a numb or tingling extremity, Mom or Dad would always tell us just to shake it, or use it, to get the blood flowing back into it.  This always worked back then, though it was sometimes very unpleasant.  Their explanation was that we had slept on the limb, restricting the blood supply into it, causing it to "go to sleep," meaning to lose sensation.  As we awoke and the blood flow was restored, the pins and needles feeling always came between the numbness and the end of the event.

Beyond that, one of the things I am trying to consider in my own case is that it's very possible that these symptoms are coming from separate causes, unrelated to one another.  Have you thought about the possibility that the tingling comes from one thing and the twitching from something else altogether?

Whatever your solution, I hope and pray you find it soon, and will share it with us here, so we can use it to help someone else.

[Lulu54]

Welcome to the side of the MS forum where you are allowed to use big medical terms like fasciculation (did I spell that right?) because if we don't know what it means we will look it up.  There is no secret code or club member only handshake here. I hope you feel welcome to post and ask lots of questions as you think of them.

When I read your originial post it didn't particularly sound like MS or ALS to me, but then again I'm not a doctor.  The viral connection with these symptoms always surprise me when I read about them  and they can take a long time to go away.  Ess is right in that if they persist, you should request to be seen by a neurologist.  We always advocate erring on the side of caution - better safe than sorry.

The mind can run pretty wild with ideas about illnesses, can't it?  When they were working on my diagnosis I started feeling every twitch and pain in my body.  My neuro equated it to being at home alone at night after all the outside noises (like the tv) are turned off - if you stay awake long enough you will hear all sorts of  creaks and moans in the house.  Our bodies do the same thing when we are in that hyper-aware state. Since my diagnosis of MS the noises are dialed back a bit in the volume, but I still hear them best when the house is quiet and I'm in bed.  

Quix will be around later - she is a west coast woman - and I would bet she has some ideas for you to check out. In the meantime feel free to hang out, read some of our health pages and learn more about MS.  

My best,
Lulu

[TJM24]

Thanks Lulu.  The empty house anology is a good one.  I find when I go to bed and quiet down for the day is when I start noticing the twitches the most.  

[Quixotic1]

Hey!  I'm glad you came on over and I apologize for the way you were treated.  We have just as much info, if not the credentials, over here.  We have a physician (me, though I was not a neuro), several PhDs and several post-docs, plus other medical professionals like nurses, Speech/Language therapists, Physical Therapists, counselors, rehab and disability specialists, students and all sorts of other involved and intelligent people.

I will start by saying that what you are going through does not sound at all like either MS nor ALS and I eill tell you why.  You have already gotten some good advice and explanations from my fellow members.

The sudden appearance of twitching of small muscle fibers that you can see and feel below the skin is a common problem.  Yes, you used the correct term when you said "fasciculations."  If a limb is actually jerking (the body is actually moving) then the twitches are not fasciculations.   I see it frequently on the General Neurology forum and we hear about it hear.  It is not DUE to stress.  But there is no doubt that stress, anxiety and worrying about it can cause it to be worse.  I hope that distintion is clear.

The docs in the know often say that a viral infection can cause this.  It makes sense.  When you think about how many viruses can make your muscles ache all over, like the beginning of a severe cold or influenza.  Any muscle or motor nerve that is irritated can develop fasciculations.  Overworking a muscle during exercise will sometimes bring them on in that muscle as athletes will attest.

Also, people can get widespread fasciculations as they begin exercising after a period of prolonged (weeks or more) inactivity, like after a severe injury or illness.  The flabby muscles get all huffy about being used again and twitch.  Okay, that isn't exactly the scientific explanation, but you get the gist.

There is a disorder called Benign Fasciculation Syndrome.  In this a person fairly rapidly develops twitches all over.  The condition by last for many nonths or years.  I believe we have a new forum on MedHelp that deal with this and similar problems.  It's called Peripheral Nerve Hyperexcitability.  You can click on the following link to talk to them also.

http://www.medhelp.org/forums/show/328

Now Lulu was spot on when she spoke of becoming so hyperaware of the sensations in your body that you begin to notice every little creak, groan and twitch, tingle and ache.  The "Empty House at Night Syndrome" - Perfect!!  This happens to any normal person who develops widespread, unknown, and concerning symptoms.  This leads to anxiety and further awareness and even imaging some symptoms.  The anxiety also cause the release of adrenaline which may further excite the peripheral nerves and cause more twitching.  So it can be an ever self-perpetuating cycle.

Now why does this not sound like ALS?  The first reason is the sensory symptoms as you noted before.  ALS is a purely motor disease.  The second is that the fasciculations of ALS are not immediately widespread.  They occur in each muscle as that muscle is dying and shriveling away - as atrophy occurs.  Fasciculation is a LATE phenomenon in ALS - not the first one.  Scratch ALS off your worry list.

Why does this not sound like MS?  Mostly because all-over fasciculations are not what happens in MS.  For the most part fasciculations are produced by the Peripheral Nervous System, the PNS.  The PNS are those nerves that have left the spinal canal and exited to the rest of the body.  MS is purely a disease of the CNS - the Central Nervous System.  The CNS is made up of the brain, the brainstem, and the spinal cord.

Yes, people with MS do have fasciculations in the distinct muscles that have lost their control nerves from the brain or spine.  We have them localized to our muscles that are atrophying from weakness and disuse.  Yes, the pins and needles can be MS symptoms, but because they appeared right with the fasciculations, it would be very odd for them not to be related.

Now that I have said all that I recommend that you see a neurologist and be checked out.  No one should rely on what they learn online - and it won't insult us at all.

I do recommend that you check the other forum.  Mark - the leader there - spent some time on this forum with the same questions as you.  He did a lot of research and learned a great deal.  He may be able to give you better answers than we can.

Welocme!

Quix

[TJM24]

Wow!  Thanks Quix.  Now that's the kind of response I was looking for from the Doc on the other forum. I feel a lot better now after reading your comments about ALS and MS.  I'm going back to my PCP just to let him know the symptoms have not abated after a few weeks and to see if he thinks a neuro exam is needed.  My symptoms do appear more left side than right (more twitching left arm and calf/foot than right).  I do wonder if a virus or other benign cause would work on one side more than being symmetrical.
I think the viral explanation makes sense. My friend had an odd virus that out of the blue paralyzed her vocal chords for 6 months.  I know I shouldn't assume the worst (ALS) but I've had a few odd medical things happen in the past that have made me think I have a black cloud of odd conditions over my head  like 2 bouts of idiopathic pancreatitis and hemochromatosis.  My mother asked me why I couldn't get something simple like a bad gallbladder or heartburn.  Oh well, thanks to some reassurance here I will be able to enjoy some time with my two year old and five year old without feeling a sense of doom and anxiety that has literally consumed me the last two weeks.  

Thanks again.

[Quixotic1]

Ahh, sorry I didn't pick that up.  My words about ALS stand.  Since the fasciculations and tingling are not as universal (bilateral) a neuro consult is more indicated.  But it doesn't change my impression that this isn't MS.

I'm glad you got some reassurance instead of a snide rebuff.

Quix

[Lulu54]

Q- my MS neuro is full of all sorts of great analogies - I liked his quiet house one.  He gave me another one last time - I'm waiting to use it if the right question pops up.  The analogy is pillaging Vikings.  Ponder that one when your brain is not so weary.

TJM,
Please check in and keep us informed how your search for answers goes.  We like to hear back because we tend to learn things that are useful for the next person searching here for answers.

be well,
Lulu

[maccalacca]

i would have your  vitamin b12 levels checked as this can affect pretty much everywhere and b12 defiency can mimic ms hope this helps