Paresthesias

[Quixotic1]

This is the beginning of a new Health Page on the ways a sensory nerve can be affected in MS.

PARESTHESIAS

One of the commonest problems is MS is that of a damaged sensory nerve causing sensation that is painful, weird, wrong, too strong, present all the time.  It can make an areas feel like it is being hurt or touched when it isn't.  It may also cause numbness or be reduced in reduced in intensity.  This pain, weirdness or numbness may occur in ANY sensory nerve.  It can happen anywhere you have feeling, including the buttocks.  It may be on one side or both, but it is more likely to be bilateral the longer you have had MS.

A erroneous sensation from a sensory nerve causes a "paresthesia. What a lot of people don't know its that there are several different kinds of sensory nerves.

The common kinds are pain, pressure, soft touch, hot, cold, and vibration, but there are another dozen types. On top of that there are the special senses: smell, sight, taste, hearing, and such. All of them can be affected by MS.

Also nerves can be affecting in two different kinds of ways. Their error messages can be positive or negative.  In the positive error the signal may send far too much signal as in pain where there is no reason for pain.  And it may send a signal all the time instead of just when stimulated.  In the negative parethesia, the nerve may fail to send any signal at all, or a reduced signal.

A POSITIVE paresthesia means that the erroroneous nerve signal will be something felt, or sensed, by the person. In the case of pain, it will be a sensation of pain from an area that is not damaged and has no reason to send a pain signal.  Hot may send a signal of a warm patch. We often perceive this as a warm, "wet" patch, but usually this "sense of wetness" is filled in by our brain because it makes sense and our brains often try to make sense of things that don't add up.  A positive pressure paresthesia may show as the band sensation we often feel in the trunk or the limbs.  And, so the sense of smell by show that is, too, is wonky, by providing us with abnormal smells. Too often these are not pleasant.  Eyes may send lights, wavy lines, colors or halos. You get the idea. Other types of positive paresthesiaS are the shooting or jabbing or electrical-shock pains that so many of us have.

A NEGATIVE paresthesia means the nerve shows its damage by not sending the signal at all, or by sending it in reduced amplitude.  Something may be completely without feeling or numb, or if the touch sensation is just reduced, it may actually feel tingly.  Something that is hot may just feel warm, or if the sensation is gone there is nothing to counter the cold sensors and the thing may actually feel cold.  The sense of smell or taste may be totally gone. The vision may lose whole segments of visual field or the color-sensing nerves may lose color saturation.

More later, questions now.

Quix

[wonko]

You know you never need to ASK for questions!  I'll start (or be near the top of) the flood.  

Sorry to repeat this, I just started a post about it and am very curious:  Do you have any comments on if/how/why paresthesias may depend on whether one is lying down, sitting, or standing?

In what mimics are initially bilateral paresthesias more likely?

Thank you!

[Rena705]

When we returned from the lake in May, I could smell garbage in the kitchen.  Now we had been away for 10 days and the garbage can had been cleaned before we left (as I always make sure I do).  I insisted that I could smell garbage and hubby said "I don't get it...I don't smell anything!"  This went on for over a week and I wouldn't even let hubby invite friends over because I thought the kitchen smelled of garbage!  He went so far as to take the trap out of the kitchen sink (which had nothing in it because it is a fairly new sink) so I cleaned all the cupboards and everything!  We found nothing and all of a sudden one day it was not there!

So now I may have a reason for what hubby calls my psycho smells!  I thought that there was an awful smell coming from the toilet in the 5th wheel which would be understandable but hubby couldn't smell it...again it just sort of went away with no explanation until now!  Well, Quix, you have saved me from the psych ward at the local hospital once again!  ha ha  

Between the problem with my ears and sense of smell and the little "sperm" in my left eye and the wavy peripheral vision in my right eye...at least I have a little more insight that I certainly wouldn't get from the evil neuro would I?

Lots of Hugs,

Rena

[Quixotic1]

WonkNot - The disorders that are most likely to cause symmetrical paresthesias are 1) those that affect the whole body like metabolic problems  (B12 deficiency, diabetes), and diffuse vaculitis (Lupus) and infections (Lyme, Syphillis) and 2) disorders of peripheral neuropathy like Guillain-Barre Syndrome, or forms of CIDP, Marie-Charchot-Tooth Disease.

If you think about it, MS does its damage one nerve at a time.  So, initially, it tends to hit one foot or arm.  But, since it has a preleliction for the same nerves, over time the paresthesias may become bilateralo, but usually not symmetrical.  That is, both feet may be numb, but one is worse or extends further up, or some such difference.

Rena - We have 4 cats and so I am paranoid about the cat boxes and odor.  When my nose goes bad I smell cat pee everywhere.  Why cant I smell cinnamon or lilacs??

Quizzle

[Quixotic1]

People with MS can have stresses on peripheral nerves, just like people without MS.  If a particular position puts a little stretch or pressure on a nerve that is damaged by MS (but which otherwise isn't damaged enough to speak ) then that nerve may show its problem.  I'm not sure that is the only answer, but It is likely one.

Quix

[LATW]

Thanks for the explanation.  I CAN NOT smell my children's messy diapers or the smell of natural gas but I do think I am smelling other awful odors no one else smells.  It is very frustrating.

Not smelling a messy diaper makes diaper changing easy but not smelling my gas stove is not a good thing.

LA

[jensequitur]

Quix, is there any information about the location of a lesion that would cause strange smells or tastes?

I think of all the paresthesia, the smells and tastes are some of the strangest.  Why is it always burning smells, or nasty smells?  Maybe because when we smell cinnamon or lilacs, it smells good and so we don't think about it.

[wonko]

So, the stabbing pain in my ear, could that be a paresthesia?  I was just thinking today that I had not had much ear pain in the past week, but here it is again, waking me up during the night.  If it is a "p," it is one of the most painful one I've had.  I get dull pains in my arms and legs (what started as tingles for me progressed to burning and sometimes pain, though I occasionally still just tingle).  I do sometimes get sharper pain, esp. in my right foot.  A few times, I have awoken with my R foot hurting so much that moving it even slightly sends sharp pains.  It eventually works out, but is a nasty issue.

I've had my ears looked at 3 times since this started happening, and no signs of infection were seen by the doc.  I wish I could look in there and check again, since an ear infection would be a more satisfying explanation!

I'm glad I've never had issues with smell.  I'd hate to lose that sense, since I love food so much.  I've been eating carefully out of concern over my symptoms, but I can still smell whatever I want!

OK, I am just cranky/silly now.  Here is a technical question, from a person who never really mastered language:  what is the plural of paresthesia?

Thanks!

[Quixotic1]

paresthesias

Stabbing pains in the ear can be something called Geniculate Neuralgia.  It is similar to the pain of Trigeminal Neuralgia which is also known as the "Suicide Pain."  Yes the stabbing, lightening jabs of pain in certain places can be excrutiating.

Pain without cause is a paresthesia

Quix

[wonko]

What would you (Quix or whomever may read this) recommend I do about this ear pain?  I first noticed it in late March.  It seems to come and go, It is not constant, but can be severe for several hours at a time (about 6 hours last night).  I've had it in both ears, but it happens more and is worse in the R ear.  

I've been to my PCP about it, and she just notes that my ear is not infected, and explicitly said that an ENT would not be able to help.  I see my neuro again soon, and will probably mention it, but I heard from his office that my recent brain MRI shows no changes from Feb. (yippee!!)  So I don't know if/how he can comment on it or help understand it.

Can this type of pain lead to hearing loss?  If not, I suppose I might just tough it out, but I would not want to put my hearing at risk.  I've read on the boards that sudden vision loss/changes is a big deal that we don't ignore.  Is that true of hearing as well?  If so, any advice on how long a hearing deficit should last before we seek urgent care?  The hearing in my R ear gets spotty sometimes, but just briefly (like minutes at a time) so I think that is still in the range of normal fluctuation.  

Usuallly I think of paresthesias as very annoying, even painful, but harmless.  Is that mostly true?

Sorry for all of the q's, and thanks for the grammar tip.  In the middle of the night, I was thinking that the plural was something funky, like "paresthesae" or something?  Do I get partial credit for creativity?

Thanks all, and hope you're having (or will have, for all of those out West) a good day.

[doni54]

Thanks, that was very informative as always.

My nose has been very sensitive for the past couple of years.  I smell things that the family never smells and sometimes they look at me like I've lost my mind. They tell me I have a better nose than our bloodhound, Sadie...ha...ha...ha.....

As for the nerve pain/damage.  I started having the nerve pain years ago, but just last summer I started with the following:  having the awful nerve pain in the calves of my legs and down around my ankles, then started running from my knees down my shins to my ankles. After a little while this pain will have intermittent numbness in these areas where the pain originates.  This has now become an everyday happening, some days the pain is worse than others, but the numbness has been present for close to four months.

Is this paresthesias?  

Thanks Quix, glad to see you back.  Hope the fatigue has let loose a little.

Love,
doni

[jensequitur]

I get this pain in my left ear, along with a muffled sensation (I need to tell the neuro about it, too!)  As to what to do about it, er...  haven't found a solution yet.  When it was really bad, I could put my warm hand over that ear, or press the little fold in front of the earhole, and it would relent.  As soon as I took my finger away, it would start up again.

[Rena705]

I get the horrible jabbing, sharp pain in my ears usually for a week or two at a time and then it lets up only to come back a week later.  It also seems that my hearing is super sensitive and I can hear things that most people don't!  My lgp is supposed to send me for a hearing test although I don't know what that will prove.  I believe that I have Geniculate Neuralgia that Quix is speaking of and I have to say that listening to myself talking with a raised voice and emptying the dishwasher are the worst for causing this agonizing pain.  I also get ringing in my ears and a whooshing sound on a regular basis although I don't know if these are considered part of the Geniculate Neuralgia.

Rena

[wonko]

Yes, I think js has mentioned the sensitivy to (certain, in terms of pitch) sounds as well in another post, I think Quix has mentioned it, and I too get that.  Some sounds, though not loud, can make me jump and have other strong reactions, even on days when I skip my coffee.  

Rustling of plastic bags/wrappers can do this.  All the more reason I use canvas bags at the store!  I used to ride a crowded commuter train, and if someone near me was eating out of a loud wrapper, I'd just about go mad and would have fists clenched the whole ride.  

I don't think I'm simply hypersenstive to sound.  Prior to my current residence in MD, I lived in W. Philadelphia for ~6 years, and I can sleep (or work, depending on time of day!) through car alarms, construction, and other loud urban noises.  The sounds that set me off are very specific, as others have shared.

It is very difficult for me to rate the duration and severity of the ear pain.  Sometimes it will be annoying, but not awful, for weeks.  Sometimes it will be stabbing and overwhelming for hours.  Like most of my mystery symptoms, it is unpredicitable.  My ear pain yesterday had a sudden onset when I laid down for bed, but did not go away by getting up or changing the elevation of my head.  

I also in general notice a correlation between my eye pain and my ear pain.  Sometimes my eyes feel swollen, and get visibly bloodshot.  This often overlaps the ear pain.  Weird, eh?

I'll need to google Geniculate Neuralgia the next time I am so inclined.

Though yesterday brough some ear pain, I'd like to share that in general, after almost 4 solid months of discomforting, interfering symptoms, over the last few days I seem to be getting a lot better!  I've been on neurontin for ~3 weeks, but I really think the underlying cause (whatever the heck that is!) is improving.  I am very excited, though using some caution since I worry that if I dive back into life at full speed it might set me back.  I didn't think this was worthy of it's own post, so I'm just tacking it on here.  I sincerely hope others who are not feeling well soon get the relief I seem to be experiencing!

Take care!

[biowham]

Quix, that was an informative and useful writeup. Thanks.

I hope you are feeling more sassy and less fatigued.

Bio

[Akcowboy]

I find it kind of odd that I can feel most deep down pain but not cuts or burns, for when I do cut myself I end up having to look around to find where the bleeding is coming from and the same with hot stuff I can be burning myself just stand by a heater and feel just the warmth of it and not knowing that I'm blistering up from the heat, It's the same thing when I'm welding and grinding

  Maybe that's why my nerou told me to stop useing any power tools and to stop welding for now lol (not happening as I need things to do)

  Cowboy

[Heartshome]

This is very helpful. I am lucky in that most of my symptoms seem to be these "Ps". However, I sometimes think that they'll drive me crazy, because even though they won't technically "hurt" me, they are always there.

Having hands and feet that buzz, tingle, are numb, and that weird pulling sensation in the palms of my hands and in my calves is a constant discomfort and a reminder that all is not well.

However, since so many here are dealing with so much more than I am, I will simply be thankful that I'm not worse off. This really helps me to understand what is happening to my body though and that's wonderful, since information is power! :)

[santana8]

I have a question. You mentioned that different segments of the vision can be lost. I was wondering if the visual field defect I have (left inferior harmonious quadrantopsia) which is loss of the left quadrant of the vision field in both eyes(or both sides of the vision field), would be considered bilateral and could this be sensory loss or parethesias  or both?

With both eyes tested separately on visual field testing, each eye shows this defect on the lower left quadrant.  The weird thing is that even though the defect is on the left in both eyes, the actual scotoma is visible to me on the right lower quadrant of my vision field.  This is because the nerve fibers from each optic nerve cross somewhere in the brain.

I guess what I am trying to ask is could this field defect be just a sensory loss of vision? If so, and if that is what it is, could this be perminent or if the nerve fibers remyelinate could this defect resolve.  I have seen a lot of my vision come back in this area, but the part that is now visible to me, looks transient or  like I can see the object there now that I couldn't see before, but  the object looks transient or shaded!!!  Could this be because the damaged nerves are being remyelinated or do you know why?

The improvements have been in spans of about a month over the last two years, very slow!!

The Parethesias in my arms and legs are also bilateral!!!

~Santana~

[Quixotic1]

Visual loss is a sensory loss.  It is completing analogous to a numb area or loss of taste.  The eyes are a specialized sensory organ.  Paresthesias happen in sensory nerves.  You seem to be asking if the vision loss is just in the optic nerve or could it be in the cerebral matter.  The answer is that I don't know.  A neuro-ophthalmologist would be able to tell you exactly where the defect is in left inferior harmonious quadrantopsia.  If the defect is found in both eyes it is by definition bilateral.

When ON causes flashing lights or halos it is the same as a paresthesia.  In general a paresthesia indicates wrong messages from a nerve and not the absence of a message.

The optic nerves come together and cross in the optic chiasm before they reach the brain.

Quix

[santana8]

My neuro- optho, optho low vision specialist, and neuro did not tell me where in the brain the vision loss came from, only that it is indeed in the brain and not in the eyes.  I have done some studying on some of the other deficits that I have had since the attack ( right/left confusion, dyscalculia, dysgraphia, dressing apraxia ect... These all can come from damage in the Parietal lobes, in which I do have lesions.  The deficits that can come from left Parietal damage that I have are in a syndrome called Gerstmann's.  One of the deficits I had at the beginning, dressing apraxia  described as damage in the right Parietal lobe.

What was interesting is that while studying the Parietal lobes  I found that optic radiations damage deep in either Parietal lobe can will produce the exact visual field defect that I have, which is not a real common one as far as visual field defects go.

I am going to take this new info into my new neuro on July 29th and ask about these deficits being caused by the Parietal lesions!

~Santana~

[landfish]

Hello,
Thanks for organizing this discussion.  I've been curiuos about the paresthesias that I've been having.  I've had some trouble concentrating lately, so you'll have to excuse me if this question has been posed and answered above already: is experiencing paresthesisas all over characteristic of MS? Given what I've read about the nature of the disease it doesn't seem like it would or should be, but of course i'm not an expert.

Thank You For Your Consideration

[MrsAristotle]

Hi
I am currently under investigation for MS, have  been for 2 years, had one MRI with stuff that could be demylination, had a positive VEP, and now changes on my second spinal MRI which shows high signal lesion on my neck effecting my T1. (Hands, arms, neck etc). Still no firm diagnoses but neuro wants an LP when I am ready for it and for now has given me a working diagnoses of Myletitis possibly MS.

Anyway one thing that bothers me more than any other symptoms is the buzzing, tingling and vibrating in a rather delicate area in a females undercarriage LOL. It is driving me mad right now, and makes it hard for me to pass water properly. Is this classed as Paresthesias and should I be worried about this?  Its also at the moment moving upwards at the back of my bottom like pins and needles. It does wear me out but thankfully it doesnt happen everyday.

My clinical signs were positive for neurological disorder. My first test a pin ***** on my left leg showed I had at the time no feeling in the bottom part of my left leg and foot. This is on and off now, but it is spreading to my right foot now.

I have big trouble at the moment after resting when I stand up, I literally cannot bend my ankles, and the pain in the bottom of my feet hurts like hell until i get moving. Is this classed as Paresthesias. This is a new symptom which has only started in the last few weeks, and i was wondering if i need to check it out with the GP. I dont like to bother her to be honest.

I found your post very informative and very helpful thank you. Maria

[sllowe]

Since you asked, I'm going to see if I've got this straight.

I think I have POSITIVE paresthesia based on this:

       Burning in my back (all the time), which falls into the write up's criteria with "too much signal."  Accompanied by a feeling of water moving around in my spine in the same area, and pressure in the spine that feels as if it's seperating.
       Though it's mild now, it's still there - doesn't go away.  

Did I get it right? Also, to add the knowledge you and paindoc gave us, how does the "neuropathic pain" fit in with this.  Since, I interpreted neuropathic to come and go, and not be constant.  

Just curious of the association between the two.

Thank you so much for this,
Shelly

[sllowe]

Oh, and, is L'Hermitte's a POSITIVE paresthesia of sorts?

thanks,
Shell

[Quixotic1]

Oh, Man!!  IU couldn't have been more wrong or misleading.  A parathesia is something that is felt that is not there.  By definition it is a positive error message.  

I'm not sure there is such a thing as a negative paresthesia.  I meant to describe it as a Negative error message.  No sensation at all when there should be one.  I will look this up and recheck my terms.

All of your questions have been great in helping me to clarify what I need to say in this post.

Pain is a special case.  Technically it IS a paresthesia, because it indicates a problem (a painful area) that doesn't actually have a reason for being painful.  But it deserves its own name.  It is called Nerve Pain or Neuropathic Pain.  Neuropathic pain can be constant, varying in intensity or constant, or it may be intermittent.  The name only applies to the cause of the pain, not the quality of the pain.

L'Hermitte's is also a paresthesia.  The nerve sends its erroneous signal when pressure or stretching from bending the neck irritates the damaged nerve in the cervical spine.

Landfish - Yes, experiencing paresthesias is very characteristic of MS.  It is not mandatory by any means, meaning you can have MS without paresthesias, but it would be rather uncommon.  I initally did not have any, but began developing them after a year or so.

AKcowboy - We have pain nerves deep inside, like in our abdomens and in the lining around our bones (called the periosteum).  These nerve can also be damaged causing pain that appears to be deep and not from the skin.

Doni - Numbness is very often associated with pain or a paresthesia.  The nerves coming from the numb are damaged and not getting proper signals through, so there is no feeling when you touch or poke the area.  However the damaged nerves are still sending a signal to the brain of pain.  The signal is originating higher up.  Both things can happen at once and is actually very common.  

all - Numbness may be complete or, more often, it is associated with some abnormal feeling, like tingling or burning.

That weird vibration that so many have is definitely a paresthesia.

I will rewrite the Paresthesia blurb to include the answers to all your questions.

Again, I should have written about Negative Nerve Error signals and Positive Nerve Error Signals.

Parethesia (Par - "other" or "abnormal" or "outside of") thesia (feeling or sensation)  Think paranormal, paramilitary, paramour

Paresthesia are when you feel wrong nerve signals.

Pain is a paresthesia, but is called Nerve Pain or Neuropathic Pain.

Numbness is a negative nerve error message - No signal being sent at all.

I will get this right and clear.

Quix