Parathesias

A very healthy active, 46 year old female; approximately 3 months ago, experienced numbness/tingling in both legs; symmetrical. Thought it was my chair or from sitting at my desk too long. Over the weekend my legs felt “over exercised” tired, achy and heavy. During exercise my legs felt very heavy. Over the next few days, parathesias now in both arms/hands, clumsy grips and tired feeling. A little tingling around my mouth. I did have “chills” during this time and it exacerbated the tingling sensations in my extremities. I have noticed some improvement but week by week not day by day. I still have residual annoying sensations in my forearms and mostly lower legs. The tired and achy feeling is occasional. Some days are better than others. Just prior to all of this happening, was started on vitamin D for a level of 13. Initially was told to go off the Vitamin D as perhaps it was causing my symptoms. B12 was WNL, MRI brain which showed insignificant white foci; ruled out MS and my cervical spine showed a small herniation but on the left side only without nerve entrapment. Neurologist could not find any causes for my symptoms from the scans. My neuro exam was essentially normal. He could not give me a definitive diagnosis. EMG was reported as normal. ANA +  with + Sjorgen’s test.  Will be seeing a Rheumatologist end of next month. I would like to know what happened to me; I have been researching all sorts of differential diagnosis including Guillan Barre, Sjorgen’s and peripheral neuropathy, small fiber neuropathy, etc… Very frustrating as I was perfectly healthy before this happened. I am trying to resume my normal activities and exercise. Any suggestions?

[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 your doctor.

Without the ability to obtain a history from you and examine you, I can not comment on a formal diagnosis or treatment plan for your symptoms. However, I will try to provide you with some information regarding this matter.

There are two types of sensory neuropathies in the body – large and small fibers. 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. The EMG/nerve conduction studies (NCS) (tests done to check for neuropathy) 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. There are several causes of small fiber neuropathy, including diabetes, vitamin deficiencies, and autoimmune problems such as Sjogren’s. I would think it is less likely that you havea  large fiber neuropathy that would be seen on EMG/NCS. Additionally, with a normal neurological examination by a neurologist, I would be more suspicious for a small fiber neuropathy with neuropathic pain/sensory abnormalities.

Treatment for neuropathic pain (pain or abnormal sensations 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).

I agree you should follow up with a rheumatologist to workup the +ve Sjogren’s test you mentioned. I would also work with your neurologist to workup the small fiber neuropathy further if he/she feels it is clinically indicated.  I highly doubt the low vitamin D level is the cause of your symptoms.  If not already done, I would also have a vitamin B6 level checked as it too can cause a small fiber neuropathy, but overall, I would be most suspicious of Sjogrens.

Thank you for using the forum, I hope you find this information useful, good luck.

[st1100]

Thank you very much for your response. I will follow up with my neurologist regarding small fiber neuropathy. What about the guillan barre; however, I do not recall an infection prior to the acute symptoms experienced. I was in Mexico ~ 4-5 days before I started to have the symptoms. Will I have any permanent damage if I elect not to take any medications? Any thoughts on if this is attributed to chronic infection. I had lab work done ~ 2 weeks prior for my annual physical and everything was WNL. It was very frightening as to what happened to me. Thanks again.