Wondering where to go from here

I am a 33 year old active mom of two little ones who has been having an "attack" of something vague, yet also very specific. I have been to the neurologist and he's been very uncommunicative, I am unsure of where to go from here. I have hand pain, muscle cramps in my legs that last for weeks, vertigo, lightheadness, drunken feeling without the euphoria, can't stand on one foot, or with my feet together, can't touch my nose with my eyes closed (I touch my forehead), my hands shake when I hold them out or try to touch something, feels like worms are crawling on the bottom of my feet, I stumble around unable to walk in a straight line and fall a LOT.  My legs occasionally buckle and I fall, I am having memory problems and the occasional slur-y words and sometimes I see the word in my head and I can't remember how to pronounce it, so I will spell it out.  My neurologist did a battery of blood tests and a MRI which has all come back normal. I don't feel normal, but I don't know where to go from here? He seems unconcerned.  Should I travel to get a second opinion at someplace like John Hopkins or Mayo Clinic? Should I beat down my current doctors door and insist on further testing, and what kind of further testing should I insist on? He had ordered neuropsycological testing, but my insurance doesn't cover it and my husband thinks all my cognitive problems are just because i have two young kids and are normal for my age - so he's not supportive of me spending a couple grand on that.   What should I do? Are there serious conditions that could cause my symptoms that wouldn't show up on an MRI that would justify my continued search, or should I just relax and pop a Xanax? Any help would be greatly appreciated.

[Neuro Forum]

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.

You describe a variety of symptoms including cramping, unsteadiness, vertigo/light-headedness, sensory symptoms in the feet, and other symptoms. These would be difficult to tie together into one diagnosis, but there are some possibilities. Non-neurologic causes such as thyroid problems is one potential cause.

An normal MRI of the brain is certainly reassuring and makes several potential causes of memory problems and other neurolgic symptoms such as MS or tumors unlikely.

Deficiencies of certain vitamins and minerals, such as vitamin B12, copper, and vitamin E, can lead to a variety of neurologic symptoms.

Sensory symptoms in the feet, associated with imbalance, could signify a neuropathy. A neuropathy is a generic term for some sort of dysfunction of the peripheral nerves.There are several categories of this type of neuropathy, and there are many many causes. 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. Vitamin B12 and B6 deficiency, as well as excess vitamin B6, can also cause neuropathy. Some toxins can cause large fiber sensory neuropathy. Other less common causes include abnormalities of protein metabolism, and paraneoplastic processes (those associated with cancer). The diagnosis of neuropathy is best assessed for based on a detailed history, examination, and with a study called EMG/NCS which assess how well the nerve conduct electricity and how well muscles respond. Rarely, in some cases a lumbar puncture provides useful in formation.

Another type of neuropathy that can lead to sensory symptoms in the feet without the other symptoms you describe is small fiber neuropathy (rather than the large fiber neuropathy discussed above). 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. The EMG/nerve conduction studies (NCS) (tests done to check for neuropathy) will not show an abnormality, and a definitive diagnosis requires other testing. There are several causes of small fiber neuropathy, including diabetes, vitamin deficiencies, autoimmune problems

On the other hand, sometimes with various non-specific symptoms, when a cause can not be found with thorough testing, and when the neurologic examination is normal (despite subjectively several symptoms being present), 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.

Continued followup with your neurologist is recommended.

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