I am losing my mind...

[canttakeanymore]

I have had for about 2 months straight now this pins and needles sensation in my lower legs.  It started from the knees down to my toes.  In addition to the pins/needles there is a weird sensation that I cannot explain, but it is that sensation that drives me up a wall.  It makes me want to kick my legs out, I can't sit still...  It progressed up to my thighs and I have this feeling 24/7.  I have muscle spasms in my legs/arms.  On bad days it's in my arms.  and last week I started having pins and needles in my lips/face.  I've been having severe headaches, my eyes twitch and I am severely tired.    My muscles ache from all the muscle spasms.  They feel tight each morning.   I noticed this morning I have weakness in my hands and arms, i tried to untie a knot for my daughter and I couldn't get my fingers to work, it kept sending this shockwave of that weird sensation into my arms.
One night I had it so bad I went to the ER - they did no tests, nothing, and gave me a valium and told me to go home and get some sleep.  the valium actually made it worse before I finally fell asleep.  I saw my GP the next day and she gave me hydrocodone which helps with the weird sensation and makes me able to do my everday activities.  But the pins/needles are always still there.    She ran all kinds of bloodwork, checked my b12 level, thyroid, checked for lymes, etc.  all of which came back normal.    She referred me to a neuro.
I have my neuro appointment tomorrow and I am not quite sure what to expect.  I know I am going to end up going in there and I'm going to break down because I cannot do this anymore.  I am hoping there is something he can do or give me to just calm this all down so I can feel normal for once.    Is there anything you can let me know of what I can expect tomorrow, is there any kind of medicine do you think he can give me that will help with my symptoms, do you know what might be going on with me?   I am so lost and confused...

[Lama Chahine, MD]

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 your doctor.

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

Many of the symptoms you describe could be explained by a neuropathy, or a problem with the peripheral nerves in the arms or legs.

There are 2 types of nerves in our body, large and small. The small nerve endings supply the skin and sweat glands. There are two types of sensory neuropathy: small fiber and large fiber (depending on the size of the nerves affected). With small fiber neuropathies, symptoms including burning or buzzing or other vague symptoms starting in the feet and hands then in some cases spreading to other parts of the body. There are several causes of small fiber neuropathy, including diabetes, vitamin deficiencies, autoimmune problems

The other type of sensory neuropathy is called a large fiber neuropathy. There are several categories of this type of neuropathy, and there are many many causes. Sensory neuropathies can involve just one nerve or several nerves in the body. The symptoms are sensory loss and if motor nerves are involved ,weakness. Some types of sensory neuropathies occur and progress very slowly, others sort of wax and wane (with flare-ups) and some are progressive. One of the most common causes of neuropathy is diabetes, and sometimes only glucose intolerances, or abnormal rises in blood sugar after a glucose load can be the only indication (this is called a oral glucose tolerance test. Other causes include but are not limited to hereditary/genetic causes, autoimmune problems, and demyelinating diseases (such as CIDP). Vitamin B12 and B6 deficiency, as well as excess vitamin B6, can also cause neuropathy. Some toxins, such as lead, arsenic, and thalium can cause large fiber sensory neuropathy. Other causes include abnormalities of protein metabolism. In many neuropathies, both the sensory and motor nerves (the nerves that supply the muscles) are involved, leading to sensory symptoms as well as weakness.

The diagnosis of large fiber neuropathy is made by findings on a test called EMG/NCS which assess how well the nerve conduct electricity and how well muscles respond. This may be something your neurologist discussed with you. Rarely, in some cases a lumbar puncture provides useful in formation, and very rarely a nerve biopsy is required. WIth small fiber neuropathy, EMG/nerve conduction studies (NCS) will not show an abnormality, and a definitive diagnosis can only be made with a skin biopsy so that the number of nerve endings can literally be counted. There are other tests of the function of small nerves that can be ordered, such as QSART testing which looks at how much sweat the skin makes, since sweating is in a sense of function of these small nerves.

Treatment for neuropathic pain (pain coming from nerves) includes neurontin and lyrica, and medications such as elavil (which is an antidepressant but has actually been found to be helpful with neuropathic pain as well).

You are on the right track with a planned evaluation by a neurologist. After he/she examines you and obtains a history, further work-up and treatment options may become available to you.

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

[txdave35]

The leg kicking could be restling leg syndrome.  I have this every now and then.  My legs just get this weird jerky sensation and they twitch.  I would go nuts if it were permanent so my heart goes out to ya.