Other tests I should consider?

[Karpaasi]

31 yr old male; no existing conditions; not taking meds:

In May I began to experience episodes that eventually landed me in the ER. They began as dull headaches/fogginess around my eyes/forehead, followed by lack of concentration, balance and lightheadedness. Always a sudden rush. The episode that landed me in the ER occured while I was at dinner one night. Sitting at dinner, I was overcome by this feeling of restlessness/ uneasiness. I couldn't sit at the table. I had to get up, walk around, go sit in the car. Eventually I started having muscle spasms throughout my body - legs, arms, chest, etc. Also felt very cold. This lasted about 45 minutes, and I've had less intense episodes since then, with the same pattern. Sudden restlessness (like I had drunk a ton of caffeine) that may last 30-45 min.'s, followed by body shakiness/tremors and then tiredness. ER bloodwork was normal, glucose normal, CT scan normal.  

Definitely some anxiety involved. I have taken lorazepam a few times during the episodes, and it's taken the edge off. MRI and EEG were negative, EMG was abnormal. B12 was 240, and Neuro wants to run more bloodwork to see if my B12 has been consistently low. I also have tremors in my hands, some in legs, and the occassional random muscle twitch anywhere.

EMG was abnormal in hand, between thumb and index finger. Spontaneous activity at rest. All other neuro signs normal.

I worry about ALS, but know it could be other things. Some past neck/arm nerve pain and wrist pain from cycling.

1. What other things can the EMG show?
2. Other tests I should consider?

[CCF-Neuro-M.D.-PW]

Muscle twitching in the absence of msucle weakness or wasting is unlikely to be ALS. It is more commonly due to a normal reaction to exercise, cold or certain medications, a benign syndrome with or without cramps, an overactive thyroid gland, pinched nerves or rarely a spinal cord disorder.

I'm not sure what you mean by the EMG was abnormal, the EMG can be abnormal in a variety of ways. The muscle you describe in the hand is the 1st dorsal interosseous muscle, a routine hand muscle tested in an EMG. It can be abnormal in problems with the ulnar nerve or higher up in the C8 nerve root; by far the most common cause is an ulnar neuropathy.
In the context of ALS, EMG evidnece of denervation must be present in at least 3 limbs for a diagnosis of ALS.

Another common cause of restlessness is restless legs syndrome, a benign condition that is diagnosed by history and can be treated effectively with medication, ask your doctor to screen you for this disorder. Stiff person syndrome can result in body (especially central) muscle spasms, ask your doctor to consider this also, it is a clinical diagnosis supported by some spinal fluid tests. Recording an EEG during an episode might also be useful to exclude a type of epileptic seizure.

Good luck

[KrisKraft]

I'm beginning to sound like a broken record on this board, but those are CLASSIC Lyme symptoms. (In the course of working on this Lyme documentary, I've interviewed many patients and gone to many conferences.)

You can see a comprehensive list of symptoms in peer-reviewed journal articles under "Symptoms and Characteristics (peer-reviewed literature)" on my website:
http://www.openeyepictures.com/underourskin/uos_resources.html

Most Lyme patients find MRIs to be worthless in diagnosis. SPECT scans are more useful because they show perfusion deficits, which are basically white matter areas of your brain not receiving good circulation because of the inflammatory processes going on when Lyme's munching way at your brain.

If you have a positive Lyme test, there's a great research trial going on with SPECT scans at Columbia, run by an excellent neuroLyme researcher, Dr. Brian Fallon.
http://www.columbia-lyme.org/flatp/resstud.html

There is very good neuroLyme symptom info on his site, too. In my opinion, IGenex, which specializes in tick-borne diseases, is the only reliable Lyme lab, because they test for multiple Lyme strains, not just the B31 Shelter Island strain, and they report on the most specific Lyme markers, the 31kDa and 34kDA bands. IGenex has recently passed Cal., NY, and CDC quality testing with flying colors. You can download the IGenex testing forms from my website; give these to your MD if you want to use this lab. MDL isn't bad a bad lab either.
http://www.openeyepictures.com/underourskin/uos_resources.html

Fewer than half the people with Lyme ever see a tick bite or a rash. The longer you have Lyme, the harder it is to get rid of.

I would strongly urge you to run to a Lyme-experienced physician, which you can find by typing in your location to "Flash Discussions", then "Find a Physician" here:
http://www.lymenet.org/

And you can also enter your symptoms under the "Medical Questions" section, and you can see what other people with similar symptoms think.

KrisKraft
http://www.lymediseasefilm.com/

[collegeftblfan]

I am not a physician, but it sounds like you had a panic attack to me, especially considering the sudden urge to get up and leave the immediate area in which the episode occured (fight or flight response).

Good luck.