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MS, White Spots, Fasciculations & Pain
I have a few questions related to "white spots" on a brain MRI and muscle twitching. Here's an extreme redaction of my history: Ten years ago I was diagnosed with "probable MS" due to two small brain lesions on MRI, loss of peripheral vision on the right side of both eyes, urgency and mild urinary incontinence, and numbness and pain in limbs (mainly on the right side) along with muscle twitching and spasms. Two years later, the brain lesions (or infarcts) hadn't changed size or position, lumbar puncture showed no demyelination, an EMG showed no muscle abnormalities, and all symptoms except for pain diminished, so my diagnosis was changed to "possible MS." Within a year my pain had gone. (There were many medications along the way, and Avonex as treatment, but I don't think listing them is relevant to my questions.)

Now I've had urinary incontinence issues for six months and muscle twitching for three months. I recently had a brain MRI that showed that the two "white spots" from ten years ago had diminished to almost nothing, and three new spots were present. A subsequent spine MRI showed a minor bulging disk at L5 S1 (looked to me like the size of a small pea on the MRI slide). The neurologist found no weakness in my limbs, and a slew of lab results all came back normal.

My biggest problem is with muscle twitching which, unless I change position or keep moving, often develops into spasms and then pain. Urgency and mild urinary incontinence persist as well. The twitching is non-stop; there has been no time in the past three-plus months that I have been without the twitching. I also have pain lasting from seconds to hours at a time in areas where there is no obvious muscle twitching/lack of movement/spasm progression, mainly in my legs, hands, and forearms. Although the twitching and pain is concentrated mainly on my right side, the twitching and pain are diffuse, occurring all over (trunk, shoulder, neck, back, stomach, almost everywhere). There's no mistaking the presence of twitching as it's visible.

I also feel like my muscles are often "vibrating" beneath my skin. My hands (especially my right hand) are always stiff; sometimes they feel stiff but not painful, other times there is tingling pain (an electrical feeling). I understand there are benign reasons for fasciculations, and that since I don't show any signs of weakness there's no indication of motor neuron disease.

I found these posts helpful re: fasciculations:
http://www.medhelp.org/posts/Neurology/Benign-Fasciculation-syndrome/show/294927
http://www.medhelp.org/posts/Neurology/ALS-worry/show/999829

I have these questions to add based on my situation:

(1) Are diffuse fasciculations seen to any significant extent in MS patients?

(2) Can infarcts in the brain caused by strokes and/or migraines disappear between one MRI and another? If so, is there a usual period of time in which this can occur?

(3) I understand that MS is the typical cause of "white spots" on brain MRIs that appear and disappear in different locations. Are there any other conditions or diseases that can cause such spots to come and go?

(4) Is diffuse muscle twitching and pain typically considered benign fasciculation syndrome (BFS)? Are there any other causes of diffuse muscle twitching?

(5) Is muscle twitching for many months considered within the realm of "normal" and "benign"? Or is it reasonable to look further for a specific cause?

(6) Is it possible that I have Parkinson's Disease?

(7) Are there any medications on the market today that are particularly good at curbing muscle twitching and related pain?

(8) I started taking amitriptyline one week ago. I understand that can help with pain. Is it also possible that it may affect (positively or negatively) the muscle twitching and spasms that seem to be underlying the pain?
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867787 tn?1318939830
Hello! I am in limboland but am thought to have MS. My Dr. has me on requip for restless leg & Zanaflex for spasms & both seem to help a little with the twitching but never completely takes it away. Mine gets alot worse at night or when I'm relaxed. I read an article that Montel Williams did where he talked about the twitches. You might repost this in the MS community as they have been wonderful, & very suppotive to me even though I'm not officially diagnosed( I'm a probable to possible MS also). I pray this helps you in some way & hope your feeling better soon. Fell free to leave a note or pm me if you have any questions. God bless you!
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