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Fasiculations & numb toes

  My husband (age 60) has experienced progressive numbness
  in his toes (both feet) for over 3 years.  Fasiculations
  are noticible in both calves, less so in thighs and
  buttocks.  We suspect fasiculations have been going
  on for years as his lower legs are closely sculpted and
  the calf muscles are bulging and knotty in appearance.
  He is unaware of the fasiculations unless he looks
  for them.  He gets up at least once or twice a night
  is unable to get back to sleep for 45 min to 1.5 hours.
  Toes are most numb lying down, numbness changes
  with type of work done during day (standing and
  leaning over seem to agravate problem.  MRI 3 years
  ago showed abnormality of parv on L5.  Circulation
  in feet is good.  Both siblings (male 62 & female 61)
  are alive and in reasonable health.  Only health
  concerns are weight (6'1" @ 230#), elevated triglycerides
  and upside down LDL/HDL ratio.  Lopid has been
  used for 5 years with reasonable success.  Neurologist
  who ordered MRI suggested further study with EMG
  which was refused by my husband.  Ditto the idea
  of back surgery.  He has made no further attempt to
  seek alternate solutions as he feels nothing can be
  done.  My concern is that these three problems
  (numb toes, fasiculations, and disrupted sleep) are
  connected and there may be some non-invasive
  approach to diagnosis and treatment that we are
  missing.  Got any ideas as to likelihood of a link
  between these and how we should procede.  Thanks.
Thanks for the question. It sounds from your question like your husband is developing a peripheral neropathy that is affecting his most distal nerves (furthest from the body). The most common cause for a PN is diabetes so that should be evaluated especially in light of the fact that he is heavey and his risk of type II diabetes is increased. Fasiculations in themselves are nonspecific findings and can be normal or associated with a number of disease states. Since his last scan was 3 years ago he really needs a new investigation. I agree with the EMG since it is a very sensative test for PN and can help tell if there is an ongoing active process. It can aklso help tell if he has a disc problem in his back causing some of the symptoms. Despite our best efforts, however, 40% of PNs go undiagnosed. Sleep problems that he is having may or may not be linked and it might be worthwhile having a sleep study. He may have sleep apnea? Does he snore alot at night. These tests are essentially non invassive. Medications can be used to help your husbands symptoms and should be discussed with his neurologist. If he wishes a consult at CCF you can call 216 444 5559. Good luck.
This information is provided for general medical education purposes. Please consult your doctor regarding diagnostic and treatment options.

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