Neurology Expert Forum
Seeking Direction for Neurological Symptoms
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This forum is for questions and support regarding neurology issues such as: Alzheimer's Disease, ALS, Autism, Brain Cancer, Cerebral Palsy, Chronic Pain, Epilepsy, Fibromyalgia, Headaches, MS, Neuralgia, Neuropathy, Parkinson's Disease, RSD, Sleep Disorders, Stroke, Traumatic Brain Injury.

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Seeking Direction for Neurological Symptoms

My symptoms began about 3 years ago.  After ruling out ALS by neurologists at Vanderbilt, I'm seeking advice regarding the direction I should take.  Currently, I'm scheduled to see a Rheumatologist in May.  Any advice is welcome!

Current symptoms:
Tingling, burning, pins & needles, Headaches, Raynaud's, Chronic Pelvic Pain Syndrome (diagnosed by two urologists), Hypogonadism (diagnosed by Endocrinologist), Arm & leg weakness, Joint pain, Pain in the left side of the throat, face and ear (muscles have seemingly gotten weaker accompanied by hoarseness) (ENT at Vandy said I had mild dysphonia) (Some problems with choking on liquids, and it seems to be getting worse), Muscle pain, Sleep Apnea (Diagnosed at Vanderbilt Sleep Clinic), Muscle twitching, Dizziness, Significant muscle tightness in my left abdomen and ribcage, Nausea, Numbness in extremities, Arms going numb while sleeping, Clouded thinking, Shortness of breath or 'Air Hunger', High Cholesterol (234) and Triglycerides (283), Pain in hands & forearms, myotonia, inflammed vessel in right eye, tinnitus
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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.

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 (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.

However, in general, when fasciculations occur in the setting of associated symptoms such as progressive loss of sensation, tingling or numbness, weakness, trouble swallowing and other symptoms, the cause may be due to a peripheral nervous system problem. These do include ALS, but other conditions such as spinal muscular atrophy, polio, west nile virus, other infections, and certain metabolic/genetic conditions can cause similar symptoms.

Another nervous system problem that can lead to muscle twitching is a neuropathy. There may again be associated weakness or sensory changes.

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. Fibromyalagia is another medical condition that leads to whole body pains, and is best treated with medications such as lyrica and neurontin, exercise, and physical therapy.

I suggest follow up with your primary doctor and you may benefit from continued evaluations by a neurologist as your primary doctor feels fit. It is important that you discuss your concerns with him/her. You may need basic lab work to ensure your blood chemistry, particularly your potassium, sodium, and calcium, is normal. Further workup such as obtaining a first or repeat EEG, EMG/NCS, and/or MRI would have to be decided upon by your neurologist depending on the clinical examination and historical findings.

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

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