autonomic neuropathy

[ellie1]

Could you please explain what autonomic neuropathy is?  I have had numbness that started in my feet progressed to lower legs, lower abdomen, lower back, part of my upper back, and in my hands.  I have had more frequently heavy pins and needled in my finger tips and they seem to have lost more sensation.  My neurologist mentioned small fiber neuropathy as a possiblilty, but my emg was ok.  This started a few years ago and seems to keep spreading all over my body and it is permanent.  The only deep numbness is in my toes and ankles but I don't want it to get deep on the other areas of my body.  Would autonomic testing help find out what it is?  I have Myasthenia Gravis also which was found in all the testing.  I have mild demylation on lower right limb, delayed latencies on both legs in ssep. I have diminished reflexes which used to be normal. Any suggestions would be appreciated.

Thanks in advance

[ccf]

Dear Ellie 1:

I am very sorry to hear about your neuropathy.  I would think your symptoms are associated with Myasthenia and not an autonomic neuropathy.  Myasthenia is caused by antibodies being produced by your body against the acetylcholine receptor (or the area around the receptor changing the way the neurotransmitter binds the receptor).  This causes weakness, usually the motor loss is greater than the sensory loss, but not always.  The usual treatment is mestinon and should control the disease in most of the cases.  An autonomic neuropathy affects specific autonomic fibers, such as for heart rate, blood pressure, etc.  There can be autonomic symptoms in myasthenia gravis but these are not the predominant symptoms.  It would be unusual for myasthenia to be limited to small fibers.  Was your EMG early in the course of the disease.  One should have seen clear signs of a neuromuscular process with changes on the EMG with muscle use. I would question the diagnosis if the EMG was negative for recruitment and changes with muscle usage.  So, I am alittle confused.  I hope that your mestonin treatment is controlling your disease and you don't need a thymus removal.

Sincerely,

CCF Neuro MD

[ellie1]

Thank you for answering.  They performed the single fiber emg which show changes such as jitter etc. that are seen in Mg in the forearm, forehead, and eyelid. and I also had the positive antibodies in my blood. My neurologist told me the numbness was not caused by the MG, so I will check with him again.  The NCV was normal and the emg done on my legs prior to the sfemg was normal.

Thanks for your answer.

[mstaffo]

Not sure how effective B12/B1 injections would be for the autonomic neuropathy, but I have had great success using them for a case of idiopathic peripheral neuropathy. I've heard of others who have had luck with various naturopathic methods treating diabetic neuropathies with alpha-lipoic acid, borage oil, cetylmirastoliate, etc.  A year ago I could barely walk, but after starting the B12/B1 injections, along with vitamin E (1200 IU of a brand with high levels of gamma tocopherol) and B-complex, the nerves started to improve. I can walk a mile & more per day now.  An M.D. with naturopathic background helped me .