Leg pain, weakness, twitching

[Chaddy4]

I have over the last 6 months been having a problem with leg pain.  At first I thought it was because I was in martial arts so I blew it off.  I quit martial arts 2 months ago.  The pain in my legs has gotten worse.  Mainly the left leg is affected, although both have a dull pain.  Recently I noticed some "shrinking" in my left leg calf muscle.  I am tired an my left leg is weak.  Both legs twitch.  Sometimes the twitching is in my face and even tongue.  I'm not stressed.  I do have epilepsy and take 300 mg lamictal a day.  Thank you!

[Chaddy4]

Thank you for the response!  I had a battery of blood test and the thyroid, cpk, sed rate, calcium, parathyroid were all within normal range.  My vitamin D was low (15).  
Could the vitamin D cause the weakness/muscle shrinking/pain that is happening?
I do have an appt with my neuro late next month.  Thank you very much!  I look forward to your response!

[Christopher R Newey, DO]

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 may have sciatica; however, it would not explain some of your symptoms. Sciatic nerve pain can come from a herniated disk causing compression on a nerve, but it can also be from masses in the pelvis or gluteal region, prolonged sitting, and hip fractures, to name a few.

If the pain is from a herniated disc (or even by a bony protrusion) compressing the nerve, the pain may spontaneously resolve in 4-6 weeks. With time, the herniated disc may actually shrink. However, a minority of patients will require surgery.  Thus, nonsurgical measures are first line as you are doing (physical therapy, ibuprofen, etc). Indications for surgery, though, can be emergent. These include muscle weakness, loss of bowel or bladder control, loss of sensation particularly in the pelvis, and severe and progressive pain. The workup for this would include clinical examination, MRI, and EMG/NCS. Twitching can be from stress/caffeine, benign fasciculation syndrome, neuropathy, ALS (typically with other features), abnormal metabolic values (such as with calcium or thyroid), etc.

I would recommend that you be seen by your primary physician regarding these symtpoms. You may need to be referred to a neurologist for the EMG/NCS which will evaluate the extent of damage done to the nerve.

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