What next

[Walter_S]

A 29 yr old male from Denver Colorado with non-specific sx's starting at the age of 15 after an infectious bout of impetigo and HSV-1. Started to develop sx's of constipation, abdominal pain, mild fatigue and mild depression. Since then sx's have been persistently expanding and getting worse. Now suffer from year round urgency, frequency (>14/dy), constipation and fatigue.

For the last 10 yearsI have exacerbation of symptoms every spring and summer around this time. With sx's of wosened fatigue, depression, lethargy, severe muscle weakness of shoulders, arms and hands bilaterally, R>L and occasional upper leg sx's. Over the last year my short term memoray has been progressively worsening w/ inability to remember names, faces and where I parked my car.  All very uncharacteristic of previous history. Last summer I experienced dysarthria, noticeable impairment in normal cognitive processing, worsening constipation and frequency and changes in coordination, Infrequent diplopia < 15 minutes and diagnosis of sleep disorder (not narcolepsy or sleep apnea). Notice occasional depression post hard cardiovascular workout. Occ paraesthesia.

PMHx:
Celiac Disease - Gluten free  for 3 years
Bipolar - On lamictal for 3 years
Sleep Disorder (Not OSA or Narcolepsy)
Insomnia
Chronic constipation
Fatigue
Urgency and Frequency
Asymptomatic Bulging disc's at C5-C6, L4-L5, L5-S1
Asthma
phx Vitamin D deficiency (20 meq/dL)
GERD
Concussion(s) - none recently


No phx of migraines, seizures, stroke, encephalitis, meningitis, vision loss, TBI,

Meds:
Lamictal 300mg Qam for 3 years
Pro-vigil 200 mg QD - TID
Ambien
Miralax
Amitiza
Prevacid

Social Hx:
Past chewing tobacco use, no phx of physical/sexual abuse, occ etoh, exercise 4/week

Neurologic exam unremarkable, reflexes, muscle strength and CN's intact. No ataxia or noted cerebellar dsfxn.
Lab work including TSH, CBC, BMP, B12 all within normal limits. ESR,CRP both WNL. Lyme titer and ANA pending.  
Radiology - MRI w/ MS protocol of head and c-spine appears negative for lesions consistent w/ MS

What next? Lumbar Puncture?
Other differential diagnosis?
Can the changes in gait and worsening memory be due to Lamictal?

Thanks,
W

[little_lady_chat]

This all sounds/seems overwhelming to you.  I'm sorry you don't have all of the answers from your doc.  I was undiagnosed for about a year and a half until the lumbar puncture.  As much as you probably hate to hear this I would highly recommend it.  This may give you some answers, and you could possibly start a trea tment if they figure anything out.  I am a pharmacy tech and I know that the meds you are taking do have different side effects varying from person to person.  I would recommend to talk to a pharmacist and get a printout of the meds you are on and then talk to doctor to see if you can possibly downsize the side effects.  Take care and hang in there - keep in touch with all of us,
Heather