worried

[emmah]

i have had different sensory problems for 7 weeks now, started with funny big toe, then tingling in hand, that comes and goes. heavy aching legs, senstive tips of fingers, which comes and goes. Twiching and jerking at rest. numb to fingers when wake up.
seen neuroglist twice beause i'm so worried it's ms or motor nuerons. my examination was normal both times and his veiw is that it is nothing neurology and i could have test but feel it would be a wasta of time. my main troubling thing is aching legs. do you think this is just worry or something bad wrong with me. had lot's of bloods done all normal. does ms or md show like this.

[SadieSunflower]

It's unfortunate that the neurologist you saw made you feel like you were wasting his time. If you've seen him twice, then you're obviously very concerned. I think it is well worth a second opinion.

[koopatroopa]

Dear Emmah,

I have similar symptoms.

Motor Neuron Diseases (MND) including ALS do not generally present with sensory symptoms so MND is unlikely. Twitching (fasciculations) without objective weakness, in the presence of a normal neurological examination, is likely NOT due to MND. For reassurance, I would suggest that you find a new neurologist and have him administer you an EMG test to rule out ALS.

Due to your constellation of sensory symptoms in your upper and lower extremeties, I recommend you ask for a cervical spine MRI, as a herniated disc with spinal cord compression or cervical stenosis could cause your symptoms. In my case, I have a herniated C3-C4 disc with cord compression, and currently awaiting surgery. Spinal cord compromise at that level in the spine can lead to myelopathy, or permanent damage to the spinal cord. Hence, I would have this evaluated sooner than later. Do you have urinary urgency/incontinence or a worsening of your symptoms when you lean your head forward (L'hermitte's sign)? The latter symptoms are indicative of spinal cord compression.

Good luck!

[emmah]

hi thanks for the reply, what are you symptoms have you had tests?

[koopatroopa]

Hi Emmah,

My symptoms are very much like yours in the legs: very achy when I stand, particularly in the left leg; however, I can run and walk just fine without too much discomfort. My symptoms in the arms are not as pronounced though: I'll have occasional flare-ups of shooting pains in my arms and neck stiffness. And yes, I have widespread fasciculations, also.

To answer your question, I've had a couple of full spine/brain MRI's with and without contrast, EMG/NCV, and two SomatoSensory Evoked Potentials (SSEP), and the following blood tests that turned out either normal or negative: ANA Panel, Sedimentation Rate, CPK, Lyme, Compl. Metabolic Panel, Fasting Glucose, Random Glucose, Hemoglobin A1C, B12, Thyroid Panel, RA, and CRP.

I'd recommend that you also rule out metabolic or systemic diseases by requesting the above blood work. The SSEP is used to detect spinal cord impingement by shocking your ankle and/or wrist and seeing if there's a delay in signal to the brain: mine were inconclusive twice.

MS can be ruled out via brain and cervical MRI's with dye.

Good luck, and feel free to write back!

[Joanna Fong, MD]

Hi emmah,

Numbness and tingling sensation in your toes and fingers can be due to many things.  Most commonly, it is due to peripheral neuropathy.  Types of peripheral neuropathy are:

1)  Polyneuropathy (multiple nerves)
2)  Mononeuropathy (single nerve)
3)  Sensorimotor (both sensory and motor nerves)
4)  Motor (motor nerve)
5)  Sensory (sensory nerve)

Causes of neuropathy:

1)  Diabetes
2)  Alcohol
3)  Nutritional (most commonly Vitamin B12 deficiency; others - B6, folate, vitamin E, copper)
4)  GBS (Guillain-Barre syndrome)
5)  Trauma
6)  Thyroid (hyperthyroidism or hypothyroidism)
7)  Entrapment (e.g. tennis elbow)
8)  Uremia (kidney problem), vasculitis (inflammation of blood vessels)

It is essential to have a good neurological examination.  Most common etiologies of peripheral neuropathy are diabetes, nutritional, thyroid.  The typical initial workup are blood tests, including TSH, HbA1c, vitamin B12, ESR, CRP, BMP.  Depending on your neurological examination, EMG/NCV (needle tests for nerves and muscles) are sometimes indicated.  Your symptoms of numbness and tingling sensation upon awakening in the mornings can be due to nerve entrapments (e.g. at the elbow or wrist; tennis elbow, carpal tunnel).  

Motor neuropathy typically presents with weakness.  A good neurological examination should be able to pick up even some subtle weakness of muscle groups.

Multiple sclerosis is a type of demyelinating disease of the central nervous system (brain and spinal