Unsure about next steps

For the last 6-9 months I've been experiencing increasing paresthesia mostly limited to my left side (face, arm and hand, glute, and leg). The locations seem very specific - up around the left side of my nose and ear and around my left eye, the bottom of my arm and my ring finger and pinky, etc. It began as mostly irritating. Lately I've been experiencing odd "buzzing" sensations in additional muscles, slamming my hand into the wall as I'm walking down the hall, overshooting when I set a small object on the table, and so on. Also, a left-sided migraine-type headache comes and goes. Nothing intolerable, but it is increasing in intensity. I also have increasing intolerance to exertion - I can go for short hikes (3-4 miles) without much elevation gain, but I pay for them with several days of extreme exhaustion and worsening neurological symptoms.

My doctor referred me to a neurologist. My MRI showed around 10 "very small" white matter lesions (the neurologist's descriptor) but my CSF tests came back normal. The neurologist says I have "possible" MS but doesn't want to start treatment yet. He wants to take a wait and see approach. I need to decide if I should relax and trust his judgment or be assertive and request treatment or additional testing to rule out other possibilities.

I should add that around 18 years ago I had a rapid onset of severe headaches, weakness, fatigue, and muscles that "gave out" on me, for lack of a better term. For example, my right hip would spasm and I would lose my balance and nearly fall. At the time I was diagnosed with chronic fatigue syndrome and basically dismissed. The headaches eased after a few months and the fatigue gradually improved. I had several similar episodes over a period of about five years. About 8 years ago I started experience odd vision symptoms (blurring, feeling like my eyes were crossing, etc.). Around the same time I noticed I was having problems with small motor movements like inserting a key into a lock. I also developed what I thought to be frequent urination along with occasional unexplained burning. Since then I developed Graves Disease (autoimmune hyperthyroid) which is now under control through medication, but it's been hard to tell what symptoms relate to what.

Thank you for any advice you can provide! Again, I need to decide how assertive I should be about this. I know sometimes MS can present with normal CFS, though this is rare as I understand it.

[Dr Sharma]

Hi there. MS is a chronic demyelinating disorder where the disease phase is characterized by active phase and remissions. It has multiple symptoms and signs and is a diagnosis of exclusion. The symptoms of multiple sclerosis are loss of balance, muscle spasms, numbness in any area, problems with walking and coordination, tremors in one or more arms and legs. Bowel and bladder symptoms include frequency of micturition, urine leakage, eye symptoms like double vision uncontrollable rapid eye movements, facial pain, painful muscle spasms, tingling, burning in arms or legs, depression, dizziness, hearing loss, fatigue etc. The treatment is essentially limited to symptomatic therapy so the course of action would not change much whether MS has been diagnosed or not. Apart from clinical neurological examination, MRI shows MS as paler areas of demyelination, two different episodes of demyelination separated by one month in at least two different brain locations. Spinal tap is done and CSF electrophoresis reveals oligoclonal bands suggestive of immune activity, which is suggestive but not diagnostic of MS. Demyelinating neurons, transmit nerve signals slower than non-demyelinated ones and can be detected with EP tests. These are visual evoked potentials, brain stem auditory evoked response, and somatosensory evoked potential. Slower nerve responses in any one of these is not confirmatory of MS but can be used to complement diagnosis along with a neurological examination, medical history and an MRI in addition, a spinal tap. Therefore, it would be prudent to consult your neurologist with these concerns. Hope this helps. Take care.