45 year scared - tremors Essential Tremor or resting - MSA?

I've seen 3 neurologists-1 is top 5 of US & have been told multiple answers-anxiety, essential tremor, somatoform. I feel both my wrists w/slight tremor when they’re under my pillow when going to sleep or when arms folded. Top Neuro/MDS said this isn’t disease, don’t have PD/MS, specific positions like under my pillow can be ET-not rest tremor-says most everything to go away-states symptoms are from herniated discs C5/C6, C6/C7-bulging,stenosis-time should heal.Am I being told this so we can wait to actual PD symptoms present?I'm scared I have M.S.A.11/5 Mother passes.11/7 Felt weakness in rt wrist. Got cold.11/8Laying on side-felt brain jerk in head-later woken w/nausea11/9 Wrist starts shaking.11/12 Rt ring finger blue under ring. Woke w/arm numb. start lorazepam Dr. gave over phone-took it, felt cold sensation in forehead.12/15 stop lorazepam.12/23-Cold back. 12/26 Woken by intense brain explosion in forehead w/electrical current (sinus) area-feel buzz moving to lt foot big toe & lt hand. Nausea feeling & sweaty.Numb feeling -forehead-1/2 in above brows-cold, prickling feeling. Sinus related?(Will this go away?)Goes down lt side of nose to cheek-Fell last summer over curb & landed on cheek, blacked out for seconds.12/28Woken by hard hand & feet shakes. Heart's racing, sweaty hands & feet. 12/29 Close to sleep, cold prickly feeling-forehead-moves faster-wakes me up.12/30 woken by hard hand & feet shakes-jaw clanking twice. 1/4-Sinus infection anti-biotic though sinuses clear, just enlarged.Dr. gives Ambien & Zoloft-took 3 days & stopped. Felt forehead get tight & rt eye moving side to side.1/21-hiked & ran steep street (lite Bladder leakage)-woke to my rt arm shaking.1/23-had normal MRI except discs-didn’t offer PT/meds-suggest beta blocker.Next 3 wks, wake-up w/shirt/sheets soaked-Took Advil-3 wks, 2-night is that why?Thyroid tested-hyper level over,but went down-Not premeno. Muscle twitching all body/toes. Did I have a seizure?Slight bladder leaking, Dry cough.

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

Essential tremor is hereditary (it runs in families). The good news about it is that besides the tremor, which is of course very bothersome to some people, it does not have other consequences (it is not neurodegenerative) in the majority of patients, though a minority develop parkinson’s disease. Propranolol is a commonly used and effective treatment for BET, but can not be used in people with asthma and some other pulmonary problems.

Other treatments for BET include primidone, or mysoline. The main side effect is sedation and it can cause allergic reaction in some people. Topamax is another medication used, its main side effect is cognitive slowing (it makes you think sort of slowly) but this improves with time and can be minimized by slowly going up on the dose. Other medications that have been tried and work include selective beta-blockers (similar to propranolol, but works selectively on more specific receptors, so that lung issues are less of a problem), and neurontin, which is useful but can cause sedation and weight gain

Most medication have one side effect or another but in the treatment of BET, they have been successful for most patients. When the tremor becomes debilitating and starts affecting daily life and occupation, there are surgical options available (called deep brain stimulation, which at this time is only done in a few centers in the world but seems highly effective).

However, you mentioned a few other things such as intermittent whole body twitching. It must be emphasized that in the MAJORITY of cases muscle twitches are benign meaning that they are of no consequence and are not resulting from a serious cause. In such cases, the twitches may be related to anxiety/stress, caffeine, and often occur after recent strenuous activity or muscle over-use. It is important in such cases to reduce stress/anxiety levels and to reduce caffeine intake. Tremors of the hands can be physiological that is exacerbated by stress/anxiety and caffeine.

Benign fasciculation syndrome, which I will abbreviate as BFS, is a condition in which there are involuntary twitches of various muscle groups, most commonly the legs but also the face, arms, eyes, and tongue. If the diagnosis is confirmed and other causes are excluded, it can be safely said that the likelihood of progression or occurrence of a serious neurologic condition is low.

When BFS is present but not particularly bothersome or disabling, treatment is not necessary. If severe and it requires treatment, there are a few medication options though this condition is not very common, and the research that has been done on its treatment is limited. Minimizing caffeine and stress, and treating anxiety if it is present, will improve your symptoms.

Another nervous system problem, neuropathy, may also lead to fasciculations. There will again be associated weakness or sensory changes. This may be important given your history of herniated discs.

If symptoms migrate (move from one place to the other), causes might include seizures, migraine disorder or metabolic problems such as low calcium. It is hard to say from your description.

Other causes do include motor neuron diseases and some infections.

Often these symptoms may reflect emotional/psychiatric problems related to stress (what is called somatization disorder). The latter is a true medical condition whereby instead of a patient experiencing depression or anxiety, they experience physical symptoms, and once the stress is addressed, the symptoms resolve.

I suggest that you continue to follow up with your neurologist. A clear diagnosis may not be available at this time, but routine follow up may provide information.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[Scared45Mom]

Thank you for your reply and information. Can essential tremors happen when laying down in specific position like the top neurologist said?