seeking answers

About 1 1/2 years ago after several traumatic events I started having some tingling in my face and arms, more twitching in eyes and lip then normal.  Had an eeg (which in the middle of testing feel like I had my first panic attack) my heart rate just jumped up to 140 and I started sweating and my facial twitching increased) I was told that she did see abnormal activity on both sides of my brain but would not label it at epilepsy but wanted to try me on heavy duty seizure med. I then went for second opinion for two days of testin in southern calif and the neuro dr there said that he did not see anything on the eeg that would indicate seizure activity, did see six lesions on my brain that he thought were due to migraines (tiny strokes) but not typical for MS. Another mri done six months later with no change. My sx's continue to increase and now I feel as though I have a continues internal shaking throughout my whole body. Feel as if I am rocking when sitting still, feel kind of dizzy or off balance at all times. At night I wake to what feels like my whole body just quivering. My husband does not visiually see anything.  I have have started with slight general muscle pains that I have never had. Somedays it is worse than others if I am tired or not feeling well.  Sometimes I will have some quick muscle jerks in my legs, arms or jaw. My muscles in my body are like jumping at all times.   I have seen a total of three neuro Dr.s and have been told maybe its just anxiety or just tremors but no definite dx's.  My friend at work has MS and has some of these same sx's.....Any ideas for me?

[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.

There are multiple causes for small lesions in the brain, what is termed white matter hyperintensities. Most often, these are due to what is called "chronic small vessel disease", literally meaning diseased small vessels that supply blood flow to the brain. This is not an uncommon process in the brain and increases with age. This is not a disease in and of itself but rather is a reflection of unhealthy blood vessels, damaged by years of plaque build-up. This is most often due to a combination of several factors including the following: high blood pressure, diabetes, smoking, and high cholesterol. If these factors are well controlled, the damage to the brain can be stabilized.

Other causes of plaques in the brain can be migraine. People with migraine often have plaques on their MRI that are of unclear cause or significance.

Other causes of plaques on MRI can usually be distinguished based on history and symptoms, such as symptoms of neurologic deficit (for example arm weakness or difficulty walking etc). These can also be distinguished based on the MRI appearance. These include, but are not limited to, multiple sclerosis, other demyelinating disease, and inflammatory processes such as vasculitis.

The different causes can be determined to some extent by interpretation of various sequences of the MRI. It sounds like your neurologist does not think the pattern of white spots in your brain are typical of multiple sclerosis. In order to make this diagnosis of MS, a detailed history and neurologic examination is required. If someone has several lesions on the brain MRI, but they have not had distinct episodes of neurologic symptoms, or they do not have specific findings on neurologic examination, then a diagnosis of MS can not be made.Other investigations are sometimes necessary to distinguish the various causes of white matter lesions.

Inner tremulousness without a visible tremor is uncommonly of neurologic cause, and is often attributed to anxiety. If there is a visible external tremor, there are several possibilities including but limited to hyperthyroidism (thyroid gland dysfunction), essential tremor, enhanced physiologic tremor, and others.

It is certainly reassuring that you have seen 3 neurologists who have not made a diagnosis of a serious neurologic disorder, but continued followup with a neurologist is recommended, and continued discussion of your symptoms and concerns with them is important. If you have been exposed to significant stress and now have episodes at night of nightmares, hypervigilance, panic attacks, one consideration is post-traumatic stress disorders (PTSD). This is of course a very disabling condition that is often treatable, and continued discussion of your symptoms and concerns with your doctor is recommended, with referral to a psychiatrist as indicated.

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